PITFALLS AND HAZARDS IN ONCOLOGICAL LAPAR OSCOPIC SURGERY

Oncological problems associated with laparoscopic colorectal surgery w ith curative intent include port site metastases, inadequate radicalit y, seeding of tumour cells through unprotected recovery of the surgica l specimen, faulty surgical technique: and failure to observe the tech nical and/or oncological limitations applicable to certain tumour site s. Investigations so far reported reveal a preponderance of mechanical pathogenesis of port site metastases caused by the contamination of t rocar entry ports by tumour cells borne on instruments, trocars and re sected material. This suggests that appropriate precautionary measures could resolve the problem. It appears that the CO2 pneumoperitoneum p lays only a minor role in the development of port site metastases. Owi ng to a lack of long-term data, the oncological radicality of laparoso pic resections for colorectal carcinoma cannot be assessed; merely a f ew reports on the number of lymph nodes removed during such operations have been published. Nevertheless, it would appear that fewer lymph n odes were removed than with comparable conventional surgery. However, a more accurate analysis needs to take account of the fact that the in dication for laparoscopic surgery is determined by the size and locati on of the tumour. The many potential pitfalls and hazards of oncologic al laparoscopic surgery make it mandatory that such interventions shou ld be done only within the framework of prospective clinical studies c overing limited indications. Randomized prospective studies to cover a ll tumour stages and sites cannot be recommended.