***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography ( CT ) examination . Methods One hundred patients out of a consecutive series of 258 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy .  The strengths of the agreement between the CT stage , the laparoscopic stage , and the final histopathological stage were determined by the weighted Kappa statistic ( Kw ) . Results The strengths of agreement between the CT stage and the final histopathological stage were Kw = 0.336 ( 95 % confidence interval [ CI ] ; 0.172–0.5 ; P = 0.0001 ) for T stage and 0.378 ( 95 % CI ; 0.226–0.53 ; P = 0.0001 ) for M stage , compared with 0.455 ( 95 % CI ; 0.301–0.609 ; P = 0.0001 ) and 0.73 ( 95 % CI ; 0.596–0.864 ; P = 0.0001 ) for the laparoscopic T and M stages , respectively . Unsuspected metastases that were not detected by CT , were found in 21 patients at laparoscopy , all of whom had T3 or T4 locally advanced tumors evident on CT . Conclusions Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical c and i date s with locally advanced disease in the absence of metastases on CT Background : Patients with potentially resectable hepatobiliary malignancy are frequently found to have unresectable tumors at laparotomy . We prospect ively evaluated staging laparoscopy in patients with resectable disease on preoperative imaging . Methods : Staging laparoscopy was performed on 410 patients with potentially resectable hepatobiliary malignancy . The preoperative likelihood of resectability was recorded . Data on preoperative imaging , operative findings , and hospital course were analyzed . Results : Laparoscopic inspection was complete in 291 ( 73 % ) patients . In total , 153 patients ( 38 % ) had unresectable disease  , 84 of whom were identified laparoscopically , increasing resectability from 62 % to 78 % . On multivariate analysis , a complete examination , preoperative likelihood of resection , and primary diagnosis were significant predictors of identifying unresectable disease at laparoscopy . The highest yield was for biliary cancers , and the lowest was for metastatic colorectal cancer . In patients with unresectable disease identified at laparoscopy , the mean hospital stay was 3 days , and postoperative morbidity was 9 % , compared with 8 days and 27 % , respectively , in patients found to have unresectable disease at laparotomy . Conclusions : Laparoscopy spared one in five patients a laparotomy while reducing hospital stay and morbidity . Targeting laparoscopy to patients at high risk for unresectable disease requires consideration of disease-specific factors ; however , the surgeons ’ preoperative impression of resectability is also important Objective The authors describe the technique of staging laparoscopy with laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors , and assess its impact on the selection of patients for hepatic resection with curative intent . Summary Background Data Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention . Laparoscopic ultrasonography is a new technique that combines the principles of high resolution intraoperative contact ultrasound with those of the laparoscopic examination , and thus , allows the laparoscopist to perform detailed assessment of the liver . Methods This study analyzes a cohort of 50 consecutive patients who were diagnosed as having potentially resectable liver tumors , and in whom staging laparoscopy was successfully undertaken .  Laparoscopic ultrasonography was performed in 43 patients , and the impact of the ensuing findings on the decision to proceed to operative assessment of resectability is examined . The resectability rate in those patients assessed laparoscopically and subsequently su bmi tted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed . Results Laparoscopy demonstrated factors precluding curative resection in 23 patients ( 46 % ) . Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients ( 33 % ) , and provided staging information in addition to that derived from laparoscopy alone in 18/43 patients ( 42 % ) . The resectability rate was significantly higher among those patients undergoing laparoscopic staging ( 93 % ) compared with those in whom operative assessment was undertaken without laparoscopy ( 58 % ) . Conclusions Staging laparoscopy with laparoscopic ultrasonography optimizes patient selection for liver resection with curative intent Peritoneal seeding or liver metastases found at laparotomy usually preclude curative treatment in patients with gastric adenocarcinoma . Such exploratory laparotomies may be avoided by diagnostic laparoscopy . However , routine diagnostic laparoscopy does not benefit those patients who proceed to laparotomy after negative laparoscopy . The aim of this study was to evaluate prospect ively the selective use of laparoscopy  in uncertain situations BACKGROUND The staging of esophageal cancer is imprecise . Thoracoscopic/laparoscopic ( TS/LS ) staging has been proposed as a more accurate lymph node ( LN ) staging method . We report the experience of an Intergroup NCI trial ( CALGB 9380 ) evaluating the feasibility and accuracy of this staging modality . PATIENTS AND METHODS From February 1995 to September 1999 , 134 patients were entered in the study . This study represents the analysis of final data on 113 patients .  TS/LS was considered feasible if TS and 1 LN sample d at least 3 LN by LS ; a confirmed positive node was found ; or T4 or M1 disease was documented . If this was accomplished in more than 70 % of patients , TS/LS was believed to be feasible . RESULTS The LN stations most frequently sample d in the thorax ( 134 patients ) were levels 2 ( 33 % ) , 3 ( 38 % ) , 4 ( 40 % ) , 7 ( 76 % ) , 8 ( 69 % ) , 9 ( 55 % ) , and 10 ( 43 % ) and in the abdomen levels 17 ( 70 % ) and 20 ( 55 % ) . The frequency of positive LN by level were as follows : 2 ( 10 % ) , 3 ( 8 % ) , 4 ( 10 % ) , 7 ( 10 % ) , 8 ( 25 % ) , 9 ( 10 % ) , 10 ( 10 % ) , 17 ( 34 % ) , and 20 ( 27 % ) . Noninvasive tests ( computed tomographic scan , magnetic resonance imaging , esophageal ultrasound scan ) each incorrectly identified TN staging as noted by missed positive or false-negative LN or metastatic disease found at TS/LS staging in 50 % , 40 % , and 30 % of patients , respectively . Median operating time was 210 minutes ( range , 40 to 865 minutes ) . Median postoperative hospital stay was 3 days ( range , 1 to 35 days ) . There were no deaths or major complications . Seventy-three percent of patients met the definition for feasibility . In 30 patients TS was not feasible . Positive LN disease was found in 43 patients ; 32 were deemed N0 . Ten patients had T4/M1 disease . Of the 32 potentially resectable N0 patients , 14 patients had preoperative induction therapy ; 13 patients went directly to operation with N0 confirmed in 9 patients , NX in 1 and N1 in 3 . Three patients were unresectable , 1 patient died , and 1 was lost to follow-up . CONCLUSIONS In summary , the feasibility of TS/LS was confirmed . It doubled the number of positive LNs identified by conventional , noninvasive staging . The overall accuracy remains to be defined by analysis of the LN negative group in follow-up . Although the positive predictive value was high , further study is warranted to confirm the role of TS/LS in the staging algorithm of esophageal cancer OBJECTIVE To assess the implication s of positive cytology for malignant cells ( positive results ) from peritoneal washings in the management of patients with pancreatic cancer . DESIGN Retrospective cohort study . SETTING Referral practice in a university hospital . PATIENTS A total of 32 consecutive pancreatic cancer patients with positive results from peritoneal washings during a 4-year period , 17 with visible biopsy-proven intraabdominal metastases at the time of laparoscopy or laparotomy and 15 without visible metastases . A treatment-matched control group of 30 patients was r and omly selected from a group of 105 patients with negative cytology for malignant cells ( negative results ) from peritoneal-fluid cytology . INTERVENTIONS Eight of 17 patients with visible metastases underwent treatment with chemotherapy , radiation , or both ; 13 of the 15 patients with no visible metastases underwent further treatment , including pancreatic resection in 2 patients and external beam radiation in 13 patients ( 3 with intraoperative radiation therapy ) . MAIN OUTCOME MEASURES Time to metastases and mortality . RESULTS Median survival among patients with and without visible metastasis was 7.8 months and 8.6 months , respectively ( P=.95 ) , despite the fact that patients without visible metastases received more treatment . Patients without visible metastases at presentation were found to have metastatic disease as documented by computed tomographic scan or subsequent laparotomy at a median time of 2.9 months . The survival of treatment-matched patients with negative cytology was significantly longer ( median , 13.5 months ; P=.04 ) . CONCLUSIONS Pancreatic cancer patients with peritoneal micrometastases have a dismal outcome even without macroscopic metastases . Since these patients do not benefit from local therapy , the finding of a positive result from peritoneal-fluid cytologic testing contraindicates further irradiation or surgery , except for specific complications BACKGROUND Accurate staging of malignant tumors in the liver has major implication s in defining prognosis and guiding both surgical and nonsurgical therapy . Intraoperative ultrasound in open surgery compares favorably with computed tomography ( CT ) in the detection of liver tumors ; however , there is little experience with laparoscopic ultrasound ( LUS ) . HYPOTHESIS Laparoscopic ultrasound is more sensitive than triphasic CT for detecting primary and metastatic liver tumors . DESIGN Prospect i ve study . SETTING University hospital . PATIENTS Fifty-five patients with a total of 222 lesions , including primary and metastatic liver tumors , who underwent both CT examinations and LUS as a part of a tumor ablation procedure . INTERVENTIONS Triphasic spiral CT scans of the liver were obtained within 1 week before surgery . Liver LUS was performed with a linear 7.5-MHz side-viewing laparoscopic transducer . RESULTS The LUS detected all 201 tumors seen on preoperative CT and detected 21 additional tumors ( 9.5 % ) in 11 patients ( 20.0 % ) . These tumors missed by CT ranged in size from 0.3 to 2.7 cm . Smaller tumors tended to be missed by CT scan ( 28.6 % of the lesions < 1 cm , 15.8 % of those 1 - 2 cm , 4 % of those 2 - 3 cm , and 0 % of those > 3 cm ) , as did those in segments III and IV . There was good correlation between the size of lesions imaged by the 2 modalities ( Pearson r = 0.86 ; P<.001 ) . CONCLUSION Laparoscopic ultrasound offers increased sensitivity over CT for the detection of liver tumors , especially for smaller lesions . This study documents the ability of LUS in detecting liver tumors and argues for more widespread use in laparoscopic staging procedures Abstract Background :  Laparoscopic colectomy  has developed rapidly with the explosion of technology . In most cases , laparoscopic resection is performed for colorectal cancer . Intraoperative staging during laparoscopic procedure is limited . Laparoscopic ultrasonography ( LUS ) represents the only real alternative to manual palpation during laparoscopic surgery . Methods : We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal cancer . Preoperative staging included abdominal US , CT , and endoscopic US ( for rectal cancer ) . Laparoscopy and LUS were performed in all cases . Pre- and intraoperative staging were related to definitive histology . Staging was done according to the TNM classification . Results : LUS obtained good results in the evaluation of hepatic metastases , with a sensitivity of 100 % versus 62.5 % and 75 % by preoperative diagnostic means and laparoscopy , respectively . Nodal metastases were diagnosed with a sensitivity of 94 % versus 18 % with preoperative staging and 6 % with laparoscopy , but the method had a low specificity ( 53 % ) . The therapeutic program was changed thanks to lapar 
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In cervical cancer , as a result of this study ,  staging laparoscopy  remains unproven .
In gastrointestinal cancer ( oesophageal , gastric , pancreatic , liver and colorectal cancers ) only prospect i ve and retrospective observational studies are available with an evidence -based level of grade B. As a result of these trials , staging laparoscopy , in a well-defined group of patients with locally advanced cancer , is recommended .
Conclusion The effects of surgical staging in gynaecological cancer must be kept in mind but can not be transferred to gastrointestinal cancer in general .