With many new techniques, there is an initial period of exuberance regarding possible additional applications that often leads to unrealistic expectations on the part of both physicians and patients. This was clearly the case with laparoscopy. The successful application of laparoscopy to procedures such as cholecystectomy led to the hope that similar benefits could be realized in patients with cancer. These benefits, which were believed to include faster recovery, shorter hospital stay, decreased pain, and earlier return to normal activity, would clearly benefit the oncology patient. Patients undergoing palliative procedures would potentially benefit by spending less time in the hospital and by requiring less pain medicine. In patients undergoing diagnostic and therapeutic procedures, a faster recovery time after surgery would potentially allow patients to begin definitive treatment regimens sooner than they could after conventional open surgical techniques. Because of this early exuberance, a large variety of procedures were initially attempted laparoscopically at M. D. Anderson. Palliative procedures performed included cholecystojejunostomy for biliary obstruction, gastrojejunostomy for gastric outlet obstruction, and small bowel bypass and colostomy for intestinal obstruction. The main therapeutic procedures performed laparoscopically for tumors of the gastrointestinal tract were in patients with colorectal cancer. The most widely applied use of laparoscopy in patients with gastrointestinal malignancies at M. D. Anderson has been for staging procedures in patients with gastric, hepatobiliary, and pancreatic cancers.

In this chapter, we discuss the role of laparoscopy in palliation, staging, and therapeutic procedures in patients with gastrointestinal malignancies. We also address the concern regarding tumor implantation in cases of laparoscopy.

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