Background: The advantages of pneumoperitoneum-based surgery are well documented. Laparoscopy is the gold standard of treatment in certain benign conditions such as cholelithiasis and
gastroesophageal disease. This success has led to the application of laparoscopy in the management
algorithm of malignant conditions. There is currently no universally accepted consensus of the role
of pneumoperitoneum-based surgery in the treatment of cancer. This is due to the early reports of
port site metastasis, initial lack of randomized controlled trials and the concern of performing oncologically
adequate operations. The aim of this section is to review the current literature and attempt
to obtain a consensus of the role of laparoscopy in the treatment of cancer.
Materials and Methods: A literature search was conducted through Pubmed with key words laparoscopy, pneumoperitoneum, carbon dioxide, malignancy, cancer, and port site metastasis. The obtained
results were divided into various sections such as non-randomized reports, randomized reports,
animal studies, human studies, etc. A comparison was made between laparoscopic and open
resections when possible.
Results: There are several published reports of studies in animal models and in humans relating to pneumoperitoneum-based surgery in the setting of malignancy. There are also a few randomized
controlled trials that compared open versus laparoscopic surgery for malignancies of various organ
systems. In addition, the early reports of alarmingly high rate of port site metastasis have been
scaled down to rates comparable to wound recurrences after open resections.
Summary: Laparoscopy has added another dimension to the managment of patients with cancer. Advanced training, superior instrumentation, and a better understanding of the pathophysiology of
carbon dioxide pneumoperitoneum has led to the successful application of laparoscopy. The improved
results are obtained in centers with high volume of patients and with experience in both fields of oncology
and minimally invasive surgery. Laparoscopy is now an integral tool in the management algorithm
of malignancies of some organ systems and its role will be further expanded in the future.
