[Standards in colorectal cancer surgery--a myth?]

The importance of so-called oncological standards is stressed every time an innovation is introduced in surgical practice. It has been stated that for colorectal cancer surgery the following oncological rules must be followed: wide tumor resection with gentle tumour removal, en bloc resection of the tumour without tumour cell spillage, no-touch isolation technique, primary ligation of the vessels and systematic lymph node dissection. Most of these oncological standards and rules are imprecise and unproven. Prognosis of the patients is not improved. Operative trauma has been shown to be associated with reproducible alterations in host immune function. This weakening of the immune system may increase risk of distant recurrence arising from exfoliated malignant cells during the operation. Up to now it is not known if laparoscopic technique diminishes these adverse effects on the immune response.