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Diagnostic staging laparoscopy: General principles for staging primary digestive malignancies

Jeffrey Marks, MD
Section Editor
Stanley W Ashley, MD
Deputy Editor
Wenliang Chen, MD, PhD


Diagnostic staging laparoscopy (DSL) is performed to determine the feasibility of the proposed curative cancer operation. DSL complements the preoperative assessment of radiographic imaging, which has limitations for identifying regional extension of the primary tumor and/or metastatic disease, such as peritoneal involvement [1,2].

The general principles and approach for performing a DSL for patients with a primary digestive malignancy are reviewed here. Laparoscopic assessment and/or resection of other malignant and benign diseases are discussed in separate topics.


The goal of diagnostic staging laparoscopy (DSL) for primary digestive malignancies is to identify and/or disprove the presence of local, regional, and/or metastatic disease. DSL aids in identifying extra-organ disease that would preclude an attempt for an intended curative resection.

Indications for DSL include [2]:

Assessment for resectability with curative intent of the following primary digestive cancers:


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Literature review current through: Sep 2016. | This topic last updated: Aug 10, 2016.
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  1. Blackshaw GR, Barry JD, Edwards P, et al. Laparoscopy significantly improves the perceived preoperative stage of gastric cancer. Gastric Cancer 2003; 6:225.
  2. Guidelines for Diagnostic Laparoscopy. Practice/Clinical Guidelines published 11, 2007, by the Society of American Gastrointestinal and Endoscopic Surgeons. www.sages.org/publication/id/12 (Accessed on June 29, 2011).
  3. Muntean V, Oniu T, Lungoci C, et al. Staging laparoscopy in digestive cancers. J Gastrointestin Liver Dis 2009; 18:461.
  4. Muntean V, Mihailov A, Iancu C, et al. Staging laparoscopy in gastric cancer. Accuracy and impact on therapy. J Gastrointestin Liver Dis 2009; 18:189.
  5. Conlon KC, Dougherty E, Klimstra DS, et al. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy. Ann Surg 1996; 223:134.
  6. Viste A, Haùgstvedt T, Eide GE, Søreide O. Postoperative complications and mortality after surgery for gastric cancer. Ann Surg 1988; 207:7.
  7. Irvin TT, Bridger JE. Gastric cancer: an audit of 122 consecutive cases and the results of R1 gastrectomy. Br J Surg 1988; 75:106.
  8. Valen B, Viste A, Haugstvedt T, et al. Treatment of stomach cancer, a national experience. Br J Surg 1988; 75:708.
  9. Shoup M, Brennan MF, Karpeh MS, et al. Port site metastasis after diagnostic laparoscopy for upper gastrointestinal tract malignancies: an uncommon entity. Ann Surg Oncol 2002; 9:632.
  10. Ziprin P, Ridgway PF, Peck DH, Darzi AW. The theories and realities of port-site metastases: a critical appraisal. J Am Coll Surg 2002; 195:395.
  11. Curet MJ. Port site metastases. Am J Surg 2004; 187:705.
  12. Taylor AM, Roberts SA, Manson JM. Experience with laparoscopic ultrasonography for defining tumour resectability in carcinoma of the pancreatic head and periampullary region. Br J Surg 2001; 88:1077.
  13. Doucas H, Sutton CD, Zimmerman A, et al. Assessment of pancreatic malignancy with laparoscopy and intraoperative ultrasound. Surg Endosc 2007; 21:1147.
  14. Pietrabissa A, Caramella D, Di Candio G, et al. Laparoscopy and laparoscopic ultrasonography for staging pancreatic cancer: critical appraisal. World J Surg 1999; 23:998.
  15. Viganò L, Ferrero A, Amisano M, et al. Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg 2013; 100:535.
  16. Connor S, Barron E, Wigmore SJ, et al. The utility of laparoscopic assessment in the preoperative staging of suspected hilar cholangiocarcinoma. J Gastrointest Surg 2005; 9:476.
  17. Kaushik N, Khalid A, Brody D, et al. Endoscopic ultrasound compared with laparoscopy for staging esophageal cancer. Ann Thorac Surg 2007; 83:2000.
  18. Yau KK, Siu WT, Cheung HY, et al. Immediate preoperative laparoscopic staging for squamous cell carcinoma of the esophagus. Surg Endosc 2006; 20:307.
  19. Bryan RT, Cruickshank NR, Needham SJ, et al. Laparoscopic peritoneal lavage in staging gastric and oesophageal cancer. Eur J Surg Oncol 2001; 27:291.
  20. Steyerberg EW, Neville BA, Koppert LB, et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006; 24:4277.
  21. de Graaf GW, Ayantunde AA, Parsons SL, et al. The role of staging laparoscopy in oesophagogastric cancers. Eur J Surg Oncol 2007; 33:988.
  22. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  23. Munasinghe A, Kazi W, Taniere P, et al. The incremental benefit of two quadrant lavage for peritoneal cytology at staging laparoscopy for oesophagogastric adenocarcinoma. Surg Endosc 2013; 27:4049.
  24. Convie L, Thompson RJ, Kennedy R, et al. The current role of staging laparoscopy in oesophagogastric cancer. Ann R Coll Surg Engl 2015; 97:146.
  25. Yano M, Tsujinaka T, Shiozaki H, et al. Appraisal of treatment strategy by staging laparoscopy for locally advanced gastric cancer. World J Surg 2000; 24:1130.
  26. Kapiev A, Rabin I, Lavy R, et al. The role of diagnostic laparoscopy in the management of patients with gastric cancer. Isr Med Assoc J 2010; 12:726.
  27. Lowy AM, Mansfield PF, Leach SD, Ajani J. Laparoscopic staging for gastric cancer. Surgery 1996; 119:611.
  28. Feussner H, Omote K, Fink U, et al. Pretherapeutic laparoscopic staging in advanced gastric carcinoma. Endoscopy 1999; 31:342.
  29. Power DG, Schattner MA, Gerdes H, et al. Endoscopic ultrasound can improve the selection for laparoscopy in patients with localized gastric cancer. J Am Coll Surg 2009; 208:173.
  30. Watt I, Stewart I, Anderson D, et al. Laparoscopy, ultrasound and computed tomography in cancer of the oesophagus and gastric cardia: a prospective comparison for detecting intra-abdominal metastases. Br J Surg 1989; 76:1036.
  31. Sarela AI, Lefkowitz R, Brennan MF, Karpeh MS. Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg 2006; 191:134.
  32. Simon M, Mal F, Perniceni T, et al. Accuracy of staging laparoscopy in detecting peritoneal dissemination in patients with gastroesophageal adenocarcinoma. Dis Esophagus 2016; 29:236.
  33. Leake PA, Cardoso R, Seevaratnam R, et al. A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer. Gastric Cancer 2012; 15 Suppl 1:S38.
  34. Abe S, Yoshimura H, Tabara H, et al. Curative resection of gastric cancer: limitation of peritoneal lavage cytology in predicting the outcome. J Surg Oncol 1995; 59:226.
  35. Bando E, Yonemura Y, Endou Y, et al. Immunohistochemical study of MT-MMP tissue status in gastric carcinoma and correlation with survival analyzed by univariate and multivariate analysis. Oncol Rep 1998; 5:1483.
  36. Burke EC, Karpeh MS Jr, Conlon KC, Brennan MF. Peritoneal lavage cytology in gastric cancer: an independent predictor of outcome. Ann Surg Oncol 1998; 5:411.
  37. Leake PA, Cardoso R, Seevaratnam R, et al. A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer. Gastric Cancer 2012; 15 Suppl 1:S27.
  38. Holzman MD, Reintgen KL, Tyler DS, Pappas TN. The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies. J Gastrointest Surg 1997; 1:236.
  39. Stefanidis D, Grove KD, Schwesinger WH, Thomas CR Jr. The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review. Ann Oncol 2006; 17:189.
  40. Nieveen van Dijkum EJ, Romijn MG, Terwee CB, et al. Laparoscopic staging and subsequent palliation in patients with peripancreatic carcinoma. Ann Surg 2003; 237:66.
  41. Ellsmere J, Mortele K, Sahani D, et al. Does multidetector-row CT eliminate the role of diagnostic laparoscopy in assessing the resectability of pancreatic head adenocarcinoma? Surg Endosc 2005; 19:369.
  42. Maire F, Sauvanet A, Trivin F, et al. Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: an indirect evaluation of the usefulness of laparoscopy. Pancreatology 2004; 4:436.
  43. Burdiles P, Rossi RL. Laparoscopy in pancreatic and hepatobiliary cancer. Surg Oncol Clin N Am 2001; 10:531.
  44. Clarke DL, Thomson SR, Madiba TE, Sanyika C. Preoperative imaging of pancreatic cancer: a management-oriented approach. J Am Coll Surg 2003; 196:119.
  45. Takhar AS, Palaniappan P, Dhingsa R, Lobo DN. Recent developments in diagnosis of pancreatic cancer. BMJ 2004; 329:668.
  46. Brooks AD, Mallis MJ, Brennan MF, Conlon KC. The value of laparoscopy in the management of ampullary, duodenal, and distal bile duct tumors. J Gastrointest Surg 2002; 6:139.
  47. Pisters PW, Lee JE, Vauthey JN, et al. Laparoscopy in the staging of pancreatic cancer. Br J Surg 2001; 88:325.
  48. Allen VB, Gurusamy KS, Takwoingi Y, et al. Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev 2016; 7:CD009323.
  49. Jimenez RE, Warshaw AL, Rattner DW, et al. Impact of laparoscopic staging in the treatment of pancreatic cancer. Arch Surg 2000; 135:409.
  50. Liu RC, Traverso LW. Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. Surg Endosc 2005; 19:638.
  51. Tilleman EH, Kuiken BW, Phoa SS, et al. Limitation of diagnostic laparoscopy for patients with a periampullary carcinoma. Eur J Surg Oncol 2004; 30:658.
  52. Vollmer CM, Drebin JA, Middleton WD, et al. Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies. Ann Surg 2002; 235:1.
  53. White R, Winston C, Gonen M, et al. Current utility of staging laparoscopy for pancreatic and peripancreatic neoplasms. J Am Coll Surg 2008; 206:445.
  54. Barreiro CJ, Lillemoe KD, Koniaris LG, et al. Diagnostic laparoscopy for periampullary and pancreatic cancer: what is the true benefit? J Gastrointest Surg 2002; 6:75.
  55. Tilleman EH, de Castro SM, Busch OR, et al. Diagnostic laparoscopy and laparoscopic ultrasound for staging of patients with malignant proximal bile duct obstruction. J Gastrointest Surg 2002; 6:426.
  56. van Delden OM, de Wit LT, Nieveen van Dijkum EJ, et al. Value of laparoscopic ultrasonography in staging of proximal bile duct tumors. J Ultrasound Med 1997; 16:7.
  57. Weber SM, DeMatteo RP, Fong Y, et al. Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients. Ann Surg 2002; 235:392.
  58. Koea J, Rodgers M, Thompson P, et al. Laparoscopy in the management of colorectal cancer metastatic to the liver. ANZ J Surg 2004; 74:1056.
  59. Cotte E, Peyrat P, Piaton E, et al. Lack of prognostic significance of conventional peritoneal cytology in colorectal and gastric cancers: results of EVOCAPE 2 multicentre prospective study. Eur J Surg Oncol 2013; 39:707.
  60. Mohan HM, O'Connor DB, O'Riordan JM, Winter DC. Prognostic significance of detection of microscopic peritoneal disease in colorectal cancer: a systematic review. Surg Oncol 2013; 22:e1.