In the last decade cancer management has become more and more complex. Increasingly, evidence-based medicine has shown a benefit for neo-adjuvant chemotherapy and radiotherapy, prior to definitive surgery, in certain stages of cancer. This has led to the realization that resection alone may not be of benefit for the cohort of patients with high risk of recurrence. Accurate pre-operative staging of cancer has become essential for optimal patient care. Traditionally, patients were subjected to open exploration often for staging purposes. If unresectable disease was found, palliative resection or bypass procedures would be performed for symptomatic control.