Clinical status of laparoscopic bowel surgery for GI malignancy

Laparoscopic colorectal surgery is being utilized increasingly for benign diseases. Recent published series have proven that morbidity and mortality from laparoscopic procedures are superior to those seen after traditional open procedures. However, although the technical feasibility of laparoscopic bowel resections has been confirmed, the oncologic advisability has not. The procedures are not yet standards of care, due to port site recurrences, inadequate lymph node harvest, inadequate resection margins, and level of ligation. At present, laparoscopic bowel resection for cure of malignancy does not confer significant benefits when compared to laparotomy and, indeed, has been associated with some serious problems. Long-term critical evaluation of large numbers of patients in prospective, randomized trials is needed to define any merits of laparoscopy. Until such data become available, laparoscopy for attempted cure of colorectal malignancy should be performed only within the context of peer-reviewed, externally monitored, prospective, randomized trials. However, these techniques are perfectly appropriate for palliation of metastatic disease.