[Laparoscopic surgery for gastrointestinal malignancies]

Since 1991, laparoscopic surgery has been applied to treat the patient with gastrointestinal malignancies. Surgery seems to be a very useful modality from the viewpoint of curability. Nevertheless, stress due to surgical procedures induces physiological responses in clinical settings. In laparoscopic surgery, intensity of surgical stress is less than that in open surgery, and physiological response involving the immunological depression after laparoscopic surgery is also less than that after open surgery, while the mesothelium on the peritoneal surface is injured with the presence of both positive intraperitoneal pressure and CO2 gas. These physiological responses as systemic effects and the wound healing responses as local effects after laparoscopic surgery may modulate the growth, invasion, and metastasis of the remnant malignancies. Various studies have been reported to clarify these effects of pneumoperitoneum. We review, herein, the literature and our preliminary results with regard to the modulation on the behavior of the malignant cells after the laparoscopic surgery.