Minimal invasive surgery in surgical oncology

BACKGROUND: The acceptance of minimal invasive surgery for the management of oncologic disease has been slow because of initial fears regarding the effect of this new approach on the interaction between the patient and the tumor. Over the last years substantial improvements have been made regarding technology and surgical experience in laparoscopy and minimal invasive procedures. Minimal invasive techniques are applied for staging, palliation and curative procedures in cancer patients. However, laparoscopic resection in curative intent for solid organ cancer is still under debate. Recently new data have emerged that might help to solve some of these issues. METHODS: A review of the literature regarding minimal invasive procedures in gastrointestinal and breast cancer patients is performed. RESULTS: In gastrointestinal cancers and lymphoma, laparoscopy has become an invaluable staging tool. The sentinel lymph node concept was shown to be a minimal invasive technique offering sufficient staging with decreased morbidity in selected breast cancer patients. However, at this time sentinel node biopsy for gastrointestinal cancer is purely investigational. From the present data from randomized trials laparoscopic colon resections are technically feasible and can be performed safely with adequate short and long term results. Presently it is not possible to make a general recommendation for laparoscopic rectal or gastric resections. No randomized trials are available. CONCLUSIONS: Within the last decade minimal invasive surgery has expanded to the staging and treatment of breast and gastrointestinal cancer patients and studies have confirmed the feasibility and safety of this approach in special indications. Growing evidence from randomized trials supports the routine use of laparoscopic resections in left and right side colonic and rectosigmoid cancer. Fewer data are available for laparoscopic rectal resections and gastric resections. Prospective randomized trials are necessary to confirm the oncologic safety in these patients.