In patients with radiologically-staged resectable oesophago-gastric junctional tumours, is diagnostic laparoscopy useful as an additional staging procedure?

A best evidence topic in surgery was written according to a structured protocol. The question addressed was in patients with oesophago-gastric junctional tumours which have been radiologically-staged as potentially resectable, is diagnostic laparoscopy useful as an additional staging procedure. 292 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. We conclude that as an additional tool following radiological staging of oesophago-gastric junctional tumours, diagnostic laparoscopy does appear to detect previously occult peritoneal metastases as well as liver metastases and lymph nodes and these findings do in turn lead to changes in management in over ten percent of patients. The procedure is however associated with some morbidity and its efficacy in changing management in the era of routine PET scanning remains to be evaluated.