Does Preoperative Laparoscopy for Gastrointestinal Tract Cancer Staging Alter Surgical Strategy? A Prospective Cohort Study

Background: Laparoscopic staging has been shown in several recent trials to minimize the necessity for exploratory laparotomy significantly among gastrointestinal (GIT) tract cancers.
Objective: Studying the importance of laparoscopy in the staging of GIT cancers to be classified as resectable or unresectable, which helps avoid an unwanted laparotomy and its morbidities.
Subjects and Methods: At GIT, Liver and Laparoscopy Unit, General Surgery Department of Zagazig University Hospitals, 24 patients with proven gastrointestinal tract carcinoma were recruited. Patients were subjected to preoperative laparoscopic staging under general anesthesia for different GIT cancers found. Pathological examination was done and compared with the computed tomography (CT) and laparoscopy results with regard to the efficacy of staging Results: The receiver operating characteristic (ROC) curve analysis of CT results in comparison with pathological results was performed to assess the sensitivity and specificity of CT concerning the efficacy of staging. The area under the ROC curve (AUC) was 0.789, the sensitivity was 80% and specificity was 78.9%. The ROC curve analysis of preoperative laparoscopic in comparison with pathological results was performed to assess the sensitivity and specificity of CT concerning the efficacy of staging. The AUC of ROC was 0.763, the sensitivity was 80.0% and specificity was 73.7%. The laparoscopy was significant in assessing resectability with sensitivity of 88.2%, specificity of 85.7%, negative predictive value (NPV) of 75% and positive predictive value (PPV) of 93.8% with accuracy of 87.5% Conclusion: Preoperative laparoscopy is considered a golden key in the staging of GIT cancers (to be classified as resectable or unresectable). Moreover, we found that this benefit aids in preventing the need for a laparotomy.