Defining the role of Staging Laparoscopy in the diagnostic algorithm of gallbladder cancers

Patients with gallbladder cancer (GBC) diagnosed at an advanced stage have poor outcomes (5-year survival rates ranging from 4 to 12%) than those diagnosed with early-stage disease (5-year survival rates of around 60-70%). Hence, a thorough preoperative evaluation is paramount for accurate staging of the disease and prognostication. This will help in reducing non-therapeutic laparotomies and surgical morbidity while also initiating systemic therapy at the earliest.

Despite the advances in imaging, the sensitivity of contrast enhanced computed tomography (CECT) for detecting metastases in GBC patients remains low, reportedly between 70 and 80%. The use of 18 Fluorodeoxyglucose positron emission tomography CT (18FDG PET CT) as an adjunct, has been shown to identify occult metastasis in almost 46% of patients with locally advanced disease. However, the accuracy of 18FDG PET CT in the detection of small nodal, liver, and peritoneal metastases smaller than 7 mm is limited by its resolution and partial volume effect.

Staging Laparoscopy (SL) has been often employed in practice to enhance the rate of detection of radiologically occult metastases, especially in patients with “high-risk” GBC. The use of SL in the diagnostic algorithm is an extrapolation from the experience of treating other gastro-intestinal malignancies.  The current study explores the possible avenues for utility of SL in the diagnostic algorithm of GBC. By developing an accurate staging tool, this research is expected to guide better clinical decision-making for patients undergoing treatment of GBCs