[Colorectal carcinoma. Minimally invasive surgery under quality aspects--limitations]

Owing to a lack of long-term survival in prospective randomized studies controversy continues to surround the use of laparoscopic resection in cases of colorectal carcinoma. However short-term survival and recurrence rate seem to be similar to conventional procedures. Mortality and morbidity rates following laparoscopic surgery seem to be equal to conventional surgery. Oncological problems associated with laparoscopic colorectal surgery with curative intent include inadequate radicality, incorrect surgical technique, and failure to observe the technical and/or oncological limitations applicable to certain tumor sites. Carcinomas of the right and left hemicolon, colon sigmoideum and of the lower rectum without a possibility of continence preservation can be safely treated by laparoscopy. All other locations, tumors with a size greater than 8 cm and tumors involving the surrounding tissue are technically demanding and difficult to be treated laparoscopically following oncological criteria. The incidence and pathogenesis of trocar site metastases are unknown. Surgical concepts to avoid these sequelae are not established.