Cancer and laparoscopy, experimental studies: a review

Objective: To review the experimental studies on laparoscopy and cancer and to propose guidelines for the clinical management of gynecologic cancer. M ethods: The literature in MEDLINE was searched from January 1992 to Decembe r 1998 using the terms 'cancer', 'laparoscopy' and 'experimental or animal study'. Cross-referencing identified additional publications. Abstracts and letters to the editor were excluded. All the relevant papers were reviewed . Results: Depending on the model used, controversial results have been rep orted on the incidence of trocar site metastasis when comparing CO2 laparos copy and laparotomy. In contrast, the following conclusions can be proposed : (i) tumour growth after laparotomy is greater than after endoscopy; (ii) tumour dissemination is worse after CO2 laparoscopy than after laparotomy; (iii) some of the disadvantages of CO2 laparoscopy may be treated using loc al or intravenous treatments or avoided using other endoscopic exposure met hods, such as gasless laparoscopy. Conclusions: The laparoscopic treatment of gynecologic cancer has potential advantages; and disadvantages, and may only be performed in prospective clinical trials. The risk of dissemination appears high when a large number of malignant cells are present. Adnexal t umours with external vegetations, and bulky lymph nodes should be considere d as contra-indications to CO2 laparoscopy. (C) 2000 Elsevier Science Irela nd Ltd. All rights reserved.