Oncologic benefits of laparoscopic and minimally invasive surgery: a review of the literature

Objective: To determine the oncologic benefits of laparoscopic and minimally invasive surgery (MIS). Background: Laparoscopy and MIS have been used increasingly in general surgery including surgical oncology. Early animal studies comparing the effect of laparoscopy and pneumoperitoneum on cancer development and progression suggested an oncological advantage with laparoscopy. Methods: We conducted a review of the literature to examine the evidence and to establish the presence or absence of oncologic benefits in patients with cancer who underwent laparoscopic resections when compared to those who had open resections. Conclusions: Laparoscopic surgery has well established short-term benefits in surgical patients, and in surgical oncology, the use of laparoscopy achieves equivalent technical aims such as margin adequacy and number of lymph nodes harvested, which are indirectly associated with oncologic outcomes. Survival and recurrence outcomes do not appear to be improved with laparoscopy, with the exception of a possible trend towards improved overall survival with laparoscopic liver resections. Unique benefits of laparoscopy in oncology include earlier access to adjuvant chemotherapy, less morbid multivisceral resections, staging, and more feasible metastasectomy (better visualization of areas of disease, and the ability to access and resect lesions in multiple locations with minimal invasiveness and tissue trauma). Definitive conclusions about the oncologic benefits of MIS will require more highly powered studies with adequate follow-up.