The role of MIS in surgical oncology: can we respect the principles?

The role of minimally invasive surgery (MIS) in surgical oncology remains a topic of great debate in human medicine where long-term studies of certain procedures that have only been performed for 15-20 years in some cases, is still not available. It is vital that good evidence-based studies evaluate the oncological outcomes of different surgical approaches as it may be that an MIS approach to certain malignancies may be inferior to more traditional open approaches.

A variety of studies do now exist to support the hypothesis that an MIS approach may aid in minimizing pain, improving return to function and decreasing the risk of surgical site infection (SSI) after surgery compared to open approaches.^1-3 In humans there is gathering evidence that the biological response to minimally invasive surgery may be superior to that seen after open surgery.⁴ These studies mainly concentrate on acute phase reactants and cellular immune responses and have shown that MIS approaches cause less interference with these normal post-operative immune responses which may account for some of the advantages in short term perioperative morbidity seen in patients undergoing MIS techniques compared to open surgery. To date the data that documents oncological outcomes after MIS in humans is variable but remains weak in veterinary medicine. While we strive to reduce perioperative pain and minimize morbidity in our patients by employing these less invasive techniques we must remember that any approach that compromises oncological surgical principles may be detrimental to long-term oncological outcomes. [...]