Tumors were more easily established and grew more aggressively after laparotomy than after insufflation. These results, coupled with those that demonstrate an immune advantage to laparoscopy over laparotomy, suggest that the difference in observed tumor growth may be related to immune function. While much work remains to be done, we believe these data provide evidence of a previously undemonstrated benefit of laparoscopic intervention.

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Local recurrence was the predominant pattern of failure and more common in those receiving individualized local therapy. De-escalation of effective therapies due to concerns about treatment toxicity should be considered cautiously.