Laparoscopic surgery and gynecologic cancer.

Laparoscopic surgery undoubtedly has a role in the management of gynecologic cancer. As a matter of fact, the current strategy in all fields of oncology is to select high-risk and low-risk patients. The reasoning behind such a strategy is essentially to avoid for the latter the hazards of heavy treatment and to lessen the cost-to-benefit ratio. With this in mind, the laparoscopic pelvic lymphadenectomy, which is the emblematic procedure in the field of oncologic laparoscopic surgery, appears to be very useful, but only in cases where an actual risk of lymph node involvement does exist and where it may be followed in patients with negative nodes by a less aggressive treatment. Gynecologic oncologists are the only ones who can at the same time make a diagnosis, decide which treatment may be done in the patients with negative nodes, and perform the needed operation. The disasters seen in relation to ovarian cysts demonstrate the danger that does exist if we allow oncologic laparoscopic surgery to fall into inexperienced hands.