Current and Future Status of Laparoscopy in Gynecologic Oncology

 

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Abstract

Laparoscopy is playing an increasingly important role in gynecologic oncology. The benefits of minimally invasive surgery for oncology patients and the quality of this treatment are well documented. Outcomes and quality of minimally invasive surgical procedures to treat cervical cancer were evaluated based on retrospective and case-control studies; outcomes and quality after minimally invasive treatment für early-stage low-risk endometrial cancer were also assessed in prospective randomized studies. If indicated, laparoscopic lymphadenectomy is both technically feasible and oncologically safe. Adipose patients in particular benefit from minimally invasive procedures, where feasible. The potential role of laparoscopy in neoadjuvant therapy for ovarian cancer and in surgery for early-stage ovarian carcinoma is still controversially discussed and is currently being assessed in further studies. Using a minimally invasive approach in gynecologic oncology procedures demands strict adherence to oncological principles and requires considerable surgical skill.

Zusammenfassung

Der Laparoskopie kommt in der gynäkologischen Onkochirurgie eine zunehmend wichtige Rolle zu. Die allgemeinen Vorteile minimalinvasiver Operationstechniken sind auch für onkologische Patientinnen mittlerweile gut belegt bei gleichzeitiger Wahrung der onkologischen Behandlungsqualität. Dies wurde für die operative Therapie des Zervixkarzinoms anhand retrospektiver und Fallkontrollstudien, für das frühe Low-Risk-Endometriumkarzinom auch prospektiv-randomisiert erfolgreich gezeigt. Eine indizierte Lymphonodektomie lässt sich sowohl technisch als auch onkologisch sicher per Laparoskopie durchführen und gerade adipöse Risikopatientinnen profitieren, wenn durchführbar, vom minimalinvasiven Vorgehen. Beim Ovarialkarzinom wird eine mögliche Rolle des laparoskopischen Zugangs im Rahmen neoadjuvanter Therapiekonzepte und zur operativen Therapie in Frühstadien kontrovers diskutiert und erfolgt daher derzeit unter Studienbedingungen. Die Durchführung gynäkoonkologischer Eingriffe mit minimalinvasivem Zugang setzt nicht nur die Einhaltung onkologischer Prinzipien, sondern auch erhebliches operationstechnisches Know-how voraus.

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