Minimal Access Cancer Management

Abstract

Minimal access approaches in the treatment of a variety of solid tumors of the stomach, large bowel, and genitourinary system are now being advocated in several surgical specialty areas. The laparoscope has evolved from a diagnostic tool to a modality that allows for removal of tumors using small incisions and the application of pneumoperitoneum with carbon dioxide. Through studies using animal models and patient investigation, the immunologic benefits of laparoscopic cancer procedures appear to be beneficial when compared with conventional laparotomy. Overall benefits of analgesic reduction, more rapid postoperative recovery, and patient satisfaction are the byproducts of minimal access approaches. Patients with cancers of the stomach, colon, and kidney show similar long-term outcomes when compared with conventional open techniques. Caution, however, should be exercised in recommending laparoscopic approaches for routine management of primary tumors of the rectum and adrenal gland.

Disadvantage of Operation Cost in Laparoscopy-Assisted Distal Gastrectomy under the National Health Insurance System in Japan

“…The reference documents retrieved by the key words ‘gastric, cancer, laparoscopic, surgery’ were 22 in PubMed with the following limits activated: Humans, Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review, English, Core clinical journals, published between January 2000 and December 2009 [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. Data regarding the following factors were considered about the clinical benefit and quality of life: operation time, blood loss, hospitalization days, duration of fasting after operaton, number of excised lymph nodes, incidence of postoperative complication.…”

Should we use laparoscopic adrenalectomy for metastases? Scandinavian multicenter study

“…In most of the cases, the finding of an adrenal metastasis is a manifestation of more systemic process [2]. Presence of metastatic lesions in adrenals has always been associated with dismal prognosis and short survival period.…”

Adrenalectomy may increase survival of patients with adrenal metastases

“…In the majority of these cases, the diagnosis of a metastatic lesion in the adrenal gland is a manifestation of other systemic processes (2). Patients with adrenal metastases have always been associated with poor prognosis and short survival periods if not treated in a timely and appropriate manner.…”

“…Laparoscopic adrenalectomy has become the 'gold standard' of treatment for benign adrenal masses (7,8). However, this remains a controversial approach for known malignant diseases (2,9,10).…”