Present status and existing problems of laparoscopic surgery for malignant gastrointestinal cancer

Abstract

Laparoscopic surgery has gained wide acceptance for its use in benign gastrointestinal cancer in the past 20 years, while its use in malignant gastrointestinal cancer has been highly controversial until the recent 3-5 years. Several prospective randomized clinical trials have suggested that the long-term outcome of laparoscopic surgery for colon cancer is the same as or better than that of open surgery. As for rectal cancer, whether the principles of total mesorectal excision can be well followed in laparoscopic surgery remains. Most recently, the trial of large number of patients doesn't show any differences upon local recurrence and 3-year survival rate between rectal cancer patients in laparoscopic group and open group. Laparoscopic surgery has been widely accepted as a standard treatment regimen for early gastric cancer in many specialized centers. Meanwhile, the feasibility and effectiveness of laparoscopic D2 lymphadenectomy for gastric cancer has been proved by several scholars. The use of laparoscopic surgery for advanced gastric cancer especially for T3 gastric cancer still remains controversial. The early concern that laparoscopic surgery for malignant cancer might increase tumor dissemination is not confirmed. The system of technical training and occupational qualification, proper selection of patients and adherence to all the principles of cancer clearance will ensure a good result of laparoscopic surgery for malignant gastrointestinal cancer. Key words: Gastric cancer; Colon cancer; Rectal cancer; Laparoscope