Cancer Biology Relating to Minimal Access Management

  • Richard L. Whelan


The use of laparoscopic techniques for the curative resection of malignancies remains the most controversial issue surrounding minimally invasive surgery today. However, because more human and animal data are available, it is now possible to address some of the fears and concerns that were raised in the early and mid-1990s regarding the appropriateness of laparoscopic methods for the treatment of malignancies. Initial concerns that it may not be possible to perform an adequate resection laparoscopically have largely been allayed by recent reports concerning large nonrandomized and several moderate-sized randomized trials of colon cancer patients. However, early reports concerning port-site tumor recurrences raised great doubts in the minds of many surgeons and served to limit sharply the number of cancer cases treated via minimally invasive means. Some believed, and indeed still believe, that there may be something inherently dangerous about minimal access surgery in the setting of malignancy, especially when carried out under a CO2 pneumoperitoneum. This widely held view is largely the result of numerous animal studies that have found CO2 pneumoperitoneum to be associated with the highest rate of port-wound tumor formation. However, when the latest human data are considered, it is now clear that fears that the incidence of port-site tumors would be manyfold greater than the open wound recurrence rate were ill-founded. Further, 3- to 5-year survival and recurrence data are becoming available from a number of nonrandomized studies, and thus far no significant differences have been noted between laparoscopic and open operation groups of patients.


Port Site Metastasis Flank Tumor Anesthesia Control Pneumoperitoneum Group Wound Tumor 
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  • Richard L. Whelan

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