de la Plaza Llamas R, Ribera Díaz D, Betancor Díaz P, Díaz Candelas DA, Latorre-Fragua RA, Gorini L, Arellano González R, Gemio del Rey IA. Staging laparoscopy in esophagogastric junction cancer: Systematic review and meta-analysis. World J Gastrointest Surg 2026; 18(1): 115285 [DOI: 10.4240/wjgs.v18.i1.115285]
Corresponding Author of This Article
Roberto de la Plaza Llamas, MD, PhD, FACS, Chief Physician and Associate Professor, Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, Universidad de Alcalá, Campus Universitario - C/ 19, Av. de Madrid, Km 33600, Alcalá de Henares 28871, Madrid, Spain. roberto.plaza@uah.es
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Surgery
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Meta-Analysis
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 28, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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de la Plaza Llamas R, Ribera Díaz D, Betancor Díaz P, Díaz Candelas DA, Latorre-Fragua RA, Gorini L, Arellano González R, Gemio del Rey IA. Staging laparoscopy in esophagogastric junction cancer: Systematic review and meta-analysis. World J Gastrointest Surg 2026; 18(1): 115285 [DOI: 10.4240/wjgs.v18.i1.115285]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 115285 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.115285
Staging laparoscopy in esophagogastric junction cancer: Systematic review and meta-analysis
Roberto de la Plaza Llamas, Diego Ribera Díaz, Paula Betancor Díaz, Daniel A Díaz Candelas, Raquel A Latorre-Fragua, Ludovica Gorini, Rodrigo Arellano González, Ignacio A Gemio del Rey
Roberto de la Plaza Llamas, Diego Ribera Díaz, Paula Betancor Díaz, Raquel A Latorre-Fragua, Ignacio A Gemio del Rey, Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares 28871, Madrid, Spain
Roberto de la Plaza Llamas, Daniel A Díaz Candelas, Raquel A Latorre-Fragua, Ludovica Gorini, Rodrigo Arellano González, Ignacio A Gemio del Rey, Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
Author contributions: De la Plaza Llamas R, Ribera Díaz D, Betancor Díaz P, Díaz Candelas DA, Latorre-Fragua RA, Gorini L, Arellano González R, and Gemio del Rey IA contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data, drafted the article or made critical revisions to important intellectual content in the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Roberto de la Plaza Llamas, MD, PhD, FACS, Chief Physician and Associate Professor, Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, Universidad de Alcalá, Campus Universitario - C/ 19, Av. de Madrid, Km 33600, Alcalá de Henares 28871, Madrid, Spain. roberto.plaza@uah.es
Received: October 15, 2025 Revised: October 29, 2025 Accepted: December 4, 2025 Published online: January 27, 2026 Processing time: 100 Days and 16.2 Hours
Abstract
BACKGROUND
Staging laparoscopy (SL) is a valuable tool for detecting occult peritoneal or hepatic metastases in patients with gastroesophageal junction (GEJ) cancer, especially when imaging suggests resectability. Despite advances in cross-sectional imaging methodologies such as computed tomography, positron emission tomography/computed tomography and endoscopic ultrasound, these techniques may miss low-volume or superficial peritoneal disease. Early identification of metastatic spread through SL can avoid unnecessary surgery, reduce morbidity, and improve treatment planning. However, its use in GEJ tumors - particularly Siewert types I and II - remains debated. Understanding the diagnostic performance (DP) of SL is essential for optimizing staging strategies.
AIM
To evaluate the DP of SL in identifying abdominal metastatic disease in patients with clinically resectable GEJ tumors.
METHODS
Systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. A comprehensive PubMed search was performed up to March 29, 2024, using Medical Subject Headings terms related to GEJ, laparoscopy, and cancer staging. Inclusion criteria: Studies assessing SL in patients with GEJ tumors. Primary outcome was the rate of upstaging to stage IV due to peritoneal or hepatic metastases. Secondary outcomes included details on techniques, patient characteristics, and procedural factors. Risk of bias was evaluated using Risk of Bias in Non-randomised Studies of Interventions and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation.
RESULTS
Eighteen studies involving 1591 patients were included. SL upstaged 22% of patients (95% confidence interval: 17-27) to stage IV due to occult metastatic disease. The pooled positivity rates were positive peritoneal malignancy (17.5%), peritoneal carcinomatosis (13%), malignant peritoneal cytology (9%), and hepatic metastases (9.2%). SL avoided unnecessary surgery in 19.8% of cases. Subgroup analysis revealed consistent performance in Siewert II tumors (DP = 13%, I2 = 0), while in Siewert I tumors it was more heterogeneous (DP = 18%, I2 = 93.7%). Only five studies reported complications, mostly minor, with no procedure-related mortality. No comorbidities, carcinomatosis scoring, conversion to open surgery, complications of follow-up, readmissions, postoperative length of stay, or delay in initiating neoadjuvant therapy were recorded.
CONCLUSION
SL improves staging accuracy in GEJ cancers, especially Siewert II. Despite heterogeneity and limited data stratification, SL may guide therapeutic decisions and help avoid unnecessary or futile surgeries.
Core Tip: Staging laparoscopy (SL) upstaged nearly one in five patients with clinically resectable gastroesophageal junction cancer by revealing occult peritoneal or hepatic metastases. This finding underlines the value of SL in refining staging and guiding treatment decisions. Diagnostic performance was especially high in Siewert II tumors, without any significant heterogeneity. However, key procedural and patient-related data were not appropriately reported across studies. These results support the routine use of SL in staging gastroesophageal junction tumors and highlight the urgent need for standardized reporting to improve risk stratification and clinical outcomes in this challenging and heterogeneous cancer subgroup.
