Key Practice Points

• Because of advances in radiologic and endoscopically guided percutaneous techniques, enthusiasm for some laparoscopic palliative procedures has diminished. However, laparoscopic colostomies and bypasses are an important option for palliation of malignant intestinal obstructions that are not amenable to percutaneous or endoscopic approaches.

• Laparoscopic staging is not of significant benefit in patients with pancreatic and hepatobiliary malignancies. In contrast, in patients with gastric cancer, in whom the incidence of missed metastatic disease on preoperative CT is about 20%, laparoscopic staging is ideal for identifying peritoneal spread as well as for providing enteral access in patients who are to undergo neoad-juvant therapy.

• Results to date with laparoscopic colon resection have been promising, but because of the technical expertise required to perform the procedure and demonstration of only minimal quality-of-life benefits, further study of laparoscopic colon resection is required.

• Large retrospective studies of the risk of port-site implantation after laparo-scopic procedures in patients with intra-abdominal and upper gastrointestinal malignancies have shown a risk of less than 1%, similar to the risk of incisional recurrence in patients undergoing open colon resection.

for laparoscopy and the increased cost associated with the procedure. Additionally, the concomitant improvements in percutaneous techniques have diminished the need for palliative laparoscopic procedures. We still believe that laparoscopic interventions can be of benefit, most notably for staging of disease in patients with gastric cancer and for performing colostomies in patients with malignant large bowel obstruction. On the basis of our series and other available data, we do not believe that tumor implantation at port sites is a significant risk for patients with gastrointestinal malignancies.

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