Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2280-2293
Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2280
Systematic review of diagnostic tools for peritoneal metastasis in gastric cancer-staging laparoscopy and its alternatives
Si Ying Adelina Ho, Kon Voi Tay
Si Ying Adelina Ho, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
Kon Voi Tay, Upper GI and Bariatric Division, General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Kon Voi Tay, Upper GI and Bariatric Division, General Surgery, Woodlands Health, Singapore 768024, Singapore
Author contributions: Ho SYA took part in screening the included studies, performed data extraction, analysed and interpreted the results, and prepared the manuscript; Tay KV led the study conception and design, took part in screening the included studies, and contributed in manuscript revision; All authors reviewed the results and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no financial conflicts or interests to disclose and no sources of funding were involved in the writing of this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Si Ying Adelina Ho, Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore 308232, Singapore. aho016@e.ntu.edu.sg
Received: March 12, 2023
Peer-review started: March 12, 2023
First decision: May 9, 2023
Revised: May 16, 2023
Accepted: June 12, 2023
Article in press: June 12, 2023
Published online: October 27, 2023
Processing time: 228 Days and 18.3 Hours
ARTICLE HIGHLIGHTS
Research background

Staging laparoscopy is currently the gold standard for diagnosing peritoneal metastasis in gastric cancer patients. However, this procedure comes with risks of general anaesthesia and surgery which are of importance in elderly and frail patients, the demographic most affected by gastric cancer. Hence, we sought to evaluate non-invasive alternatives to staging laparoscopy with comparable accuracy.

Research motivation

Staging laparoscopy remains the gold standard for diagnosing peritoneal metastasis in gastric cancer patients, which comes with risks of general anaesthesia and surgery. Many non-invasive diagnostic modalities are available in the current day and age, hence, we sought to evaluate non-invasive alternatives to staging laparoscopy that may provide us with comparable accuracy. With further research in this field, along with newer developments such as radiomic modelling and new radiotracers, there is great potential for developing such a diagnostic tool with comparable or even greater accuracy than staging laparoscopy.

Research objectives

We sought to determine if computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) could be a potential non-invasive yet accurate alternative to staging laparoscopy.

Research methods

Data from relevant studies that reported patients with peritoneal metastasis secondary to gastric cancer diagnosed by non-invasive scans were extracted and presented according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Significant data such as sensitivity, specificity, negative and positive predictive values were analysed and compared between diagnostic modalities in our systematic review.

Research results

Our findings suggested that staging laparoscopy still delivered the best results in terms of sensitivity, specificity, negative and positive predictive values when compared to CT scans in diagnosing peritoneal metastasis in advanced gastric cancer. MRI had generally outperformed CT scans which had in turn, generally performed better than PET scans. Despite this, the difference in performance between all the diagnostic modalities are marginal, suggesting that there is great potential for the development of the ideal diagnostic tool capable of providing us with the same or even better accuracy than staging laparoscopy, while remaining non-invasive. With additional tools such as radiomic modelling and new radiotracers, the development of such a diagnostic modality may be possible sooner than expected.

Research conclusions

Although staging laparoscopy remains superior to other non-invasive diagnostic modalities in the detection of peritoneal metastasis in advanced gastric cancer, the potential for developing a comparable or even better diagnostic tool is great. This may be achieved with new technologies such as radiomic modelling and new radiotracers, on top of the already advanced capabilities of CT, MRI and PET scans. With further research, this breakthrough may be possible sooner than expected.

Research perspectives

Given the rapid and enthusiastic development of new technologies in diagnostic tools, the development of a highly sensitive and specific non-invasive alternative to staging laparoscopy in peritoneal metastasis detection is highly likely with further research. On top of the already cutting edge diagnostic modalities, additional improvements and developments may bring us closer than ever to this goal.