Pitfalls and hazards in oncological laparoscopic surgery

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Abstract
Oncological problems associated with laparoscopic colorectal surgery with curative intent include port site metastases, inadequate radicality, seeding of tumour cells through unprotected recovery of the surgical specimen, faulty surgical technique, and failure to observe the technical and/or oncological limitations applicable to certain tumour sites. Investigations so far reported reveal a preponderance of mechanical pathogenesis of port site metastases caused by the contamination of trocar entry ports by tumour cells borne on instruments, trocars and resected material. This suggests that appropriate precautionary measures could resolve the problem. It appears that the CO2 pneumoperitoneum plays only a minor role in the development of port site metastases. Owing to a lack of long-term data, the oncological radicality of laparosopic resections for colorectal carcinoma cannot be assessed; merely a few reports on the number of lymph nodes removed during such operations have been published. Nevertheless, it would appear that fewer lymph nodes were removed than with comparable conventional surgery. However, a more accurate analysis needs to take account of the fact that the indication for laparoscopic surgery is determined by the size and location of the tumour. The many potential pitfalls and hazards of oncological laparoscopic surgery make it mandatory that such interventions should be done only within the framework of prospective clinical studies covering limited indications. Randomized prospective studies to cover all tumour stages and sites cannot be recommended.

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