In comparison with open surgery,laparoscopic surgery is more beneficial for patients with gastrointestinal neoplasms in serveral aspects,including better preservation of gastrointestinal and pulmonary function,less immunosuppression,shorter hospital stay and improved postoperative recovery.However,this minimally invasive surgery is more technically complex and hasn't got enough consent by patients.To improve the long-term outcomes,the laparoscopic techniques need to be standardized and carried out by skilled surgeons.Based on the reviewed advancement in this field and our own experience,we believe that laparoscopic surgery would be increasingly adopted as the gold standard for gastrointestinal neoplasms when its efficacy has been proved by adequate evidence from randomized controlled trials in the near future.

Medical quality is always the precondition for the development of medical techniques.To achieve a high quality of minimally invasive surgery,several issues should be addressed which include correct guidelines and standardization of the techniques,high quality evidences from multi-center randomized controlled studies,proper training system for the techniques and constantly innovations to improve the techniques,We believe that only the high quality could bring the minimally invasive surgery a even brighter future.

Laparoscopic surgery for gastrointestinal neoplasms has made remarkable progress in the past 20 years.Laparoscopic surgery for patients with colon cancer is increasingly adopted by surgeons based on the evidence from randomized controlled studies.Minimally invasive surgery is also adopted as an alternative procedure for early gastric cancer.On the other hand,despite high levels of evidences supporting the safety of laparoscopic surgery for gastrointestinal neoplasms, a major proportion of these surgeries continue to be performed by open techniques. How to standardize and correctly disseminate the minimally invasive techniques for gastrointestinal surgery is still a problem which we have to confront in the current era. We believe that the persistent efforts of gastrointestinal surgeons will lead to the widespread adoption of minimally invasive gastrointestinal surgery in the near future.

Laparoscopic surgery for colorectal cancer has the advantages of minimal impairment of gastrointestinal and pulmonary function, less immunosuppression and shorter hospital stay, which had been appoved by evidence-based medicine. With the development of concepts and techniques of minimally invasive surgery, the combination of laparoscope and endoscope in the treatment of colorectal cancer has attracted surgeons' attention, and some conventional surgery techniques of colorectal-anal anastomosis have been adopted during laparoscopic colorectal resection, which make ultra-low anastomosis feasible. The aspects mentioned above will promote the further development of laparoscopic surgery for colorectal cancer.

Since Dr.Mouret first introduced the laparoscopic technique into chokcystectomy,a new surgical era has arrived.With the rapid development of minimally invasive technique,it is now playing an important role in the surgical treatment of gastrointestinal cancers.Almost all kinds of gastric operations,such as wedge resection,distal gastrectomy,proximal gastrectomy and total gastrectomy with or without lymph node resection can be achieved with a laparoscope.In China,laparoscopic gastrectomy has been widely applied in many experienced medical centers and great progress has been achieved in the treatment of early and advanced gastric cancer.Laparoscopic colonic surgery has been recognized as one of the standard operations by NCCN.In Asian countries like China,Japan and Korea,laparoscopic rectal surgery following the TME principle has been widely applied.Because of the rapid development of laparoseopic gastrointestinal surgery in China,the Chinese Society of Laparoendoscopic Surgery has published standardized guidelines and established training centers for the development of young Surgcons.

Recent clinical trials suggested that epidermal growth factor receptor (EGFR) targeted agents could benefit many patients with colorectal cancer. This article reviews the clinical efficacy of cetuximab, which is an antibody directed at the EGFR, in the treatment of metastatic colorectal carcinoma. Several articles about EGFR-targeted therapies in metastatic colorectal carcinoma and other solid tumors were reviewed. Cetuximab showed the increase in progression-free survival (3.98 months vs 2.56 months, P

With the standardized training and spreading,laparoscopic total mesorectal excision for rectal cancer has been spread nationwide.The oncological adequacy and long-term outcomes have also been confirmed by series of randomized controlled trials such as COLOR Ⅱ in Europe.There were still some technical issues,such as safe surgical plane,surgical approach,lymph node dissection,and function-preserving,which were still under debate.In the current article,authors will discuss the issues with clinical experiences about preserving of Denonvilliers facial,preserving of pelvic autonomic nerve,strategy of surgical approach,dissection of lateral lymph nodes,and necessity of protective diverting stoma.

Three-dimensional (3D) laparoscopic surgery has been developed rapidly in China since 2012.Based on mature two-dimensional (2D) laparoscopic surgery,3D laparoscopic surgery has the same technique as 2D,with similar indication as 2D as well.However,3D laparoscopic surgery can offer better depth description,more accurate spatial location,and less error in operation.It might offer better visional experience if hybrid with virtual reality or with 4K in the future.But in current status,laparoscopy with 3D technique is only a technique with innovation,but not a revolutionary technique.

Laparoscopic surgery for upper-third gastric cancer has gradually been accepted by experienced surgeons as the mature of this technique.Different from the standardized and programmed D2 lymph node dissection in Laparoscopy-assisted Billroth Ⅰ gastrectomy,the indications and methods for laparoscopic splenic hilar lymphadectomy in the upper-third gastric cancer remains controversial.Unsolved problems include joint organs resection,appropriate surgical approach selection and variable vascular anatomy of the splenic hilum.Meanwhile,the long-term efficacy and safety of laparoscopic splenic hilar lymphadectomy for the upper-third gastric surgery need to be confirmed by evidence-based medical trials.With the advance of the theory and clinical practice,laparoscopic splenic hilar lymph node dissection will continue to progress.

Objective To determine whether the pressure of continuous CO 2 pheumoperitoneum (CCP) affects port site implantation of tumor cells.Methods Male SD rats were injected intraperitoneally with gastric cancer cells (cell line SGC 7901). Continuous CO 2 pneumoperitoneum at 15*!mm*!Hg or 30*!mm*!Hg for 5*!mins,60*!mins,120*!mins and 180*!mins with different number of tumor cell injection(10 4/ml, 10 6/ml respectively) was then established. Several samples of peritoneal washing served as positive control.All collecting dishes were incubated at 37℃ for one week.Results Dishes were tumor cell positive on which the tumor cells were collected from rats undergoing continuous flows of CO 2 gas (5*!L/min) at pneumoperitoneum of 30*!mm*!Hg for 60 mins or longer and all peritoneal washing samples showed tumor growth also. Conclusion It suggests that the number of tumor cells, pneumoperitoneum pressure and the duration may affect the port site implantation.