Minimally invasive surgery and cancer: controversies part 1

Abstract

Perhaps there is no more important issue in the care of surgical patients than the appropriate use of minimally invasive surgery (MIS) for patients with cancer. Important advances in surgical technique have an impact on early perioperative morbidity, length of hospital stay, pain management, and quality of life issues, as clearly proved with MIS. However, for oncology patients, historically, the most important clinical questions have been answered in the context of prospective randomized trials. Important considerations for MIS and cancer have been addressed, such as what are the important immunologic consequences of MIS versus open surgery and what is the role of laparoscopy in the staging of gastrointestinal cancers? This review article discusses many of the key controversies in the minimally invasive treatment of cancer using the pro-con debate format.

Fig. 1

Placement of ports

Fig. 2

Complete dissection of #6 and 14v lymph nodes. RGEA, right gastroepiploic artery; RGEV, right gastroepiploic vein; SMV, superior mesenteric vein

Fig. 3

Completion of radical D2 lymph node dissection. LGA, left gastric artery; PHA, proper hepatic artery; CHA, common hepatic artery

Fig. 4

Complete dissection of #11d lymph node dissection. SpA, splenic artery

Fig. 5

Intracorporeal esophagojejunostomy by linear stapled end-to-side anastomosis