David M. Ota, MD, FACS

One of the most important prognostic factors in colorectal cancer is the presence or absence of regional lymph node metastases. In many instances, micrometastatic disease may not be found on routine pathologic analysis using hematoxylin and eosin staining, but may be discovered only with immunohistochemical methods or polymerase chain reaction assay.

Laparoscopic procedures have become standard surgical techniques for several benign abdominal diseases. Laparoscopic cholecystectomy, appendectomy, Nissen fundoplication, splenectomy, adrenalectomy, and palliative intestinal bypass procedures are widely accepted as standards of care. It was believed that the success of these laparoscopic procedures would soon transform colorectal surgery for neoplastic diseases. This enthusiasm is evident in many early publications cited in the article by Drs. Wexner and Hwang. The article offers a balanced and thorough review of laparoscopy in the management of colorectal neoplasms and emphasizes the significant controversy surrounding this topic.

The article by Milsom and Hammerhofer reviews the promising aspects of laparoscopic colon resection as well as the controversies surrounding it. Laparoscopic cholecystectomy ushered in a new era of abdominal surgery. This minimally invasive surgical technique has been applied to other benign diseases, such as appendicitis and reflux esophagitis.