Laparoscopic surgery for cancer: are we ready?

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Oncology

Background:

• Laparoscopic approaches are increasingly documented for digestive cancer treatment through large prospective studies and randomized trials.
• Concerns regarding port-site recurrences have diminished, but long-term follow-up remains a challenge for laparoscopic surgeons.
• Staging laparoscopy (SL) is valuable for esophageal, gastric, pancreatic, hepatobiliary cancers, and lymphomas, often altering clinical staging and patient management.

Purpose of the Study:

• To review the current evidence and feasibility of laparoscopic approaches in the surgical treatment of various digestive cancers.
• To assess the benefits and limitations of laparoscopy in the context of perioperative outcomes and long-term follow-up for digestive malignancies.
• To evaluate the role of laparoscopy in staging and treatment planning for gastrointestinal and hepatobiliary cancers.

Main Methods:

• Review of prospective studies, randomized trials, and surgical series documenting laparoscopic procedures for digestive cancers.
• Analysis of evidence regarding the efficacy, safety, and perioperative outcomes of laparoscopic surgery for specific digestive cancers.
• Evaluation of the impact of staging laparoscopy on clinical staging and patient management.

Main Results:

• Laparoscopic surgery demonstrates shorter perioperative morbidity and hospital stays for esophageal and gastric cancer.
• Staging laparoscopy provides significant value in staging and management alteration for esophageal, gastric, pancreatic, hepatobiliary cancers, and lymphomas.
• Laparoscopy is safe and applicable for small malignant liver lesions and laparoscopy-assisted colectomy shows significant benefits, particularly for stage III disease.
• Laparoscopic resection of pancreatic malignancies is not yet established as feasible or beneficial, and curative resection for early gallbladder cancer is a poor indication.

Conclusions:

• Laparoscopic surgery is a safe and applicable approach for many digestive cancers, with demonstrated benefits in specific procedures like colectomy and liver lesion resection.
• While challenges in long-term follow-up and specific indications (e.g., pancreatic cancer) persist, the evidence supports the expanding role of laparoscopy in digestive cancer care.
• Further trials are warranted in many areas, but the field is progressing towards a widespread adoption of laparoscopic techniques in digestive cancer surgery.