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Invited Commentary

Heidi Nelson, MD
Arch Surg. 1994;129(9):900. doi:10.1001/archsurg.1994.01420330014002.
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SURGERY REMAINS the primary mode of treatment of curable colon cancer. Optimal surgery maximizes the accuracy of exploratory and lymphadenectomy staging information, while minimizing the risk for tumor recurrence through wide bowel margins and minimal tumor handling. With the recent application of minimally invasive techniques to resection of colonic malignant neoplasms, concerns have been raised regarding whether laparoscopic techniques can offer equivalent oncologic outcomes.

Several reports suggest that laparoscopic techniques are equivalent to traditional surgical approaches in terms of extent of resection, margins, and completeness of lymphadenectomy.1,2 Despite these reports, at least two issues remain unresolved. The first issue regards the adequacy of laparoscopic exploratory staging procedure, which is reduced from palpation and inspection of the abdominal cavity to visual inspection alone. The second regards possible alterations in patterns of recurrence. Several anecdotal but alarming instances of trocar site recurrence have been reported within months following laparoscopic procedures.3

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