Impact of Gas(less) Laparoscopy and Laparotomy on Peritoneal Tumor Growth and Abdominal Wall Metastases

Abstract

ObjectiveA tumor model in the rat was used to study peritoneal tumor growth and abdominal wall metastases after carbon dioxide (002) pneumoperitoneum, gasless laparoscopy, and laparotomy. Summary Background DataThe role of laparoscopic resection of cancer is under debate. Insufflation of the peritoneal cavity with C02 is believed to be a causative factor in the development of abdominal wall metastases after laparoscopic resection of malignant tumors. MethodsIn the solid tumor model, a lump of 350-mg CC-531 tumor cells was placed intraperitoneally in rats having C02 pneumoperitoneum (n = 8), gasless laparoscopy (n = 8), or conventional laparotomy (n = 8). After 20 minutes, the solid tumor was removed through a laparoscopic port or through the laparotomy. In the cell seeding model, 5 x 105 CC-531 cells were injected intraperitoneally before C02 pneumoperitoneum (n = 12), gasless laparoscopy (n = 12), or laparotomy (n = 12). All operative procedures lasted 20 minutes. After 6 weeks, in the solid tumor model and after 4 weeks in the cell seeding model, tumor growth was scored semiquantitatively. All results were analyzed using the analysis of variance.

Effects of laparoscopy on intraperitoneal tumor growth and distant metastases in an animal model

“…Similar results were achieved by the same authors with a cell suspension of CC531. 34 These results are supported by Watson et al, 37 who demonstrated that the incidence of port-site metastases in a rat model was reduced after gasless laparoscopy compared with insufflation with CO 2 .…”

“…Jacobi et al 32 showed that the simple act of creating a CO 2 pneumoperitoneum caused increased tumor growth within the peritoneal cavity. Work by Bouvy et al 33,34 using both cell suspension and solid tumor models achieved similar results. In contrast, the results of Hubens and Eyskens 35 showed no difference in the rate intraperitoneal tumor growth between anesthetic controls and CO 2 insufflation.…”

“…38 However, studies generally demonstrate that this effect is less with laparoscopy. [32][33][34][35]39 These studies have examined the effects of laparoscopy on tumor growth at a site remote from the peritoneal cavity, such as the animal's flank, and may help to explain some of the differences between their findings and our study.…”

Incidentally Detected Gallbladder Cancer- The Controversies and Algorithmic Approach to Management

“…The incidence of port site recurrences in IGBC after LC was 0-40 % in various reported series [13][14][15][16]. The proposed theories for port site recurrences include gallbladder perforation and bile spillage, direct physical and chemical influence of pneumoperitoneum, improper specimen extraction and increased abdominal pressure on tumour cell diffusion [13,14,17]. Paolucci et al reported an incidence of 17.1 % port site recurrence over a median period of 6 months after LC [14].…”

Port site metastasis after laparoscopic cholecystectomy

“…Although the mechanism of the abdominal wall recurrence is still unclear, it is speculated that two major factors may be involved: the systemic progression of the malignancy and the local implantation [2]. Laparoscopic handling of the tumour, perforation of GB, spurting of CO 2 gas containing tumour cells through the port site (so called Chimney Phenomenon) and extraction of the specimen without an endobag may be the risk factors [2].…”