Current status of laparoscopic surgery in colorectal cancer

Laparoscopic colorectal procedures offer several benefits postoperatively, including reduction of pain, minimal impairment of pulmonary and gastrointestinal function, and improved reconvalescence. At present, laparoscopic resections for colorectal cancer are discussed controversially due to oncologic radicality, potential tumor dissemination, and the fundamental problem of port-site metastases. Oncologic standards of open surgery for colorectal cancer are not compromised by the laparoscopic technique. Short-term results of both retrospective and prospective trials comparing open with laparoscopic surgery for colorectal cancer showed comparable oncologic outcomes related to recurrence and survival. Despite extensive research efforts, neither the incidence of port-site recurrence nor its causes have been clarified definitely. However, according to the preliminary results of recently published studies, the problem of port-site metastases may not be an inherited detriment of laparoscopic surgery, but rather an unfortunate sequel to the learning curve of the application of laparoscopic surgery in colorectal cancer. Finally, as long-term results of prospective randomized trials are still missing, the crucial issue whether laparoscopic resection for colorectal cancer is oncologically equivalent to open surgery, cannot be answered definitely. Therefore, in the interim, laparoscopic curative resections in colorectal cancer are only to be offered within prospective randomized trials.