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World J Gastroenterol. Feb 21, 2014; 20(7): 1777-1789
Published online Feb 21, 2014. doi: 10.3748/wjg.v20.i7.1777
Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution
Lapo Bencini, Marco Bernini, Marco Farsi
Lapo Bencini, Marco Bernini, Marco Farsi, Division of Surgical Oncology, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
Author contributions: Bencini L ideated and designed the research; Bencini L, Bernini M and Farsi M performed the research and contributed to the final draft of the paper.
Correspondence to: Lapo Bencini, MD, PhD, Division of Surgical Oncology, Department of Oncology, Careggi University Hospital, Azienda Ospedaliero-Universitaria di Careggi Largo Brambilla 3, 50134 Florence, Italy. lapbenc@tin.it
Telephone: +39-55-7947404 Fax: +39-55-7947451
Received: October 12, 2013
Revised: November 7, 2013
Accepted: November 28, 2013
Published online: February 21, 2014
Abstract

After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts, some surgeons started to treat malignancies by the same way. However, if the limits of laparoscopy for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies. Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy, worsened quality of life due to surgery itself and adjuvant therapies, and challenging psychological impact. All these issues could, potentially, receive a better management with a laparoscopic surgical approach. In order to confirm such aspects, similarly to testing the newest weapons (surgical or pharmacologic) against cancer, long-term follow-up is always recommendable to assess the real benefits in terms of overall survival, cancer-free survival and quality of life. Furthermore, it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies. Therefore, laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for inflammatory bowel diseases, gastroesophageal reflux disease or diverticular disease. This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.

Keywords: Gastrointestinal cancer, Laparoscopic, Oncology, Laparoscopic surgery, Robotic surgery, Surgical outcomes, Oncologic outcomes

Core tip: Laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for benign diseases. Oncologic outcomes remain the foundation of any procedures to cure malignancies, hence a long-term follow-up is always recommendable in order to asses overall survival, cancer-free survival and quality of life.