The value of laparoscopic surgery to stage gynecological cancers: present and future

The laparoscopic management of gynecologic cancers has been discussed controversely since decades. Much progress has been achieved technically enabling an experienced endoscopic surgeon to perform most of the gynecologic oncologic procedures such as hysterectomy, omentectomy, pelvic and paraaortic lymph node dissection. Although the value of laparoscopy with respect to oncological safety and patient's outcome has not been shown in prospective randomized clinical trials, many studies with altogether thousands of patients have revealed the feasibility and also similar oncologic results of laparoscopy when compared to laparotomy. Therefore, the laparoscopic approach has become well accepted for certain oncological indications, especially when early stage cancer cases are treated. These indications are also subject to ongoing Phase III trials: The LACC001 trial compares Total Laparoscopic Radical Hysterectomy (TLRH) or total robotic radical hysterectomy with total abdominal radical hysterectomy (TARH) for the treatment of early stage cervical cancer. The GOG LAP 2 and also the LACE001 trial compare total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) for the treatment of early stage endometrial cancer, whereby bilateral salpingo-oophorectomy, pelvic and paraaortic lymph node dissection is performed according to tumor stage and grade. This review summarizes the current status of laparoscopy in gynecologic oncology based on the literature to date, the ongoing clinical trials, and the recommendations of the German Gynecologic Oncology Group (AGO).