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. Methods: The literature in MEDLINE was searched from January 1992 to December 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 reported on the incidence of trocar site metastasis when comparing CO 2 laparoscopy 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 CO 2 laparoscopy than after laparotomy; (iii) some of the disadvantages of CO 2 laparoscopy may be treated using local or intravenous treatments or avoided using other endoscopic exposure methods, 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 tumours with external vegetations, and bulky lymph nodes should be considered as contra-indications to CO 2 laparoscopy.