Laparoscopy in gynecological oncology [Laparoskopie in der gynäkologischen onkologie]

Background. Laparoscopy is increasingly being used for operative treatment of gynecological malignancies. Aim. This article supplies answers to the following questions: what are the indications in gynecological oncology for laparoscopic operations? Does one of the open surgical procedures offer comparable oncological safety? Material and methods. An analysis of the literature was carried out with respect to prospective randomized trials. This article summarizes the important publications on endo - scopic operative procedures for endometrial, cervical and ovarian cancer as well as borderline ovarian tumors. Results. Operative treatment of early stage endometrial and cervical cancer can be carried out using laparoscopy, including pelvic and para-aortic lymphadenectomy. The current data suggest that there is comparable oncological safety between laparoscopy - and laparotomy. Surgical staging can be used to assess the retroperitoneal para-aortic lymph node status before chemoradiation of locally - advanced cervical cancer. Operative treatment of early stage ovarian cancer should be carried out via midline incision laparotomy because of a superior evaluation of the bowels, retroperitoneum and upper abdomen. Laparoscopy plays an important role in the diagnostics of cancer of unknown primary (CUP) syndrome and to acquire tissue biopsies before neoadjuvant chemotherapy. Borderline ovarian tumors can be treated laparoscopically without impairing patient prognosis. Conclusions. Laparoscopy of early stage endometrial and cervical cancer and borderline ovarian tumors can be performed with oncological safety and comparable prognosis to open surgery. Invasive ovarian cancer should be treated via open surgery. In cases of advanced stage gynecological malignancies laparoscopy provides a diagnostic tool facilitating the assessment of the para-aortic lymph node status before chemoradiation of cervical cancer and allows acquisition of tissue biopsies of ovarian cancer before neoadjuvant chemotherapy. © Springer-Verlag 2014.