In vivo real-time analysis of intraperitoneal radiolabeled tumor cell movement during laparoscopy

Abstract

Tumor cells move throughout the peritoneal cavity both at rest and during CO2 insufflation. The pattern of tumor cell dispersion differs with CO2 insufflation. The presence of blood and extended contact of trocars with peritoneal contents are a major factor in trocar and trocar site tumor cell contamination.

Protection of trocar sites from gallbladder cancer implantation by sodium hyaluronate shill carboxymethylcellulose?based bioresorbable membrane (Seprafilm) in a nurine model

“…The cause of the port site metastasis has been debated in many reports, and several mechanisms have been proposed, such as seeding due to contact with instruments contaminated with tumor cells [7], the seeding of tumor cells via aerosolization [18], and local immunity due to the CO 2 pneumoperitoneum and metabolic effects [13]. We have also previously shown in a murine model that the peritoneal open wound increases the frequency of port site metastasis and peritoneal dissemination [1].…”

Rapid flow carbon dioxide laparoscopy disperses cancer cells into the peritoneal cavity but not the port sites in a new rat model

“…There were no gasless control in subjects this study. On the other hand, Hewitt et al [9] demonstrated that cells are dispersed through fluid transport in the absence of insufflation, but that insufflation changes the pattern of dispersal, which may explain the two positive results in our gasless cohort. In our flow groups, however, desiccation of the peritoneal cavity made aerosolization as the mechanism of dispersal more likely than fluid transport.…”

“…It was necessary to use this concentration because previous work by Wu et al [28] suggested a dose-response effect of inoculum size on aerosol formation, and models using small inocula(500-666 cells/g) have failed to show any evidence of aerosolization [9]. The number of cells aerosolized may be so small that indirect methods such as polymerase chain reaction may be necessary to detect them, shown by Reymond et al [25] in a small number of patients with pancreatic cancer.…”

Influence of pneumoperitoneum on tumor implantation in parietal incision: a comparative study of trocar incision and laparotomy in rats

“…Clinical studies have shown the possibility of videolaparoscopy techniques presenting higher incidence of parietal metastasizing. Pneumoperitoneum, for contributing to a phenomenon called aerosolization, is the most questioned factor for this fact 39,66,70,73,74,78,81,94 . However, the relation between pneumoperitoneum and the forms of tumor cell dissemination and tumor implantation is not clear 4,11,33,41,43,45,49,54,68 .…”

“…However, the literature reports tumor implantation even in trocar wounds not used to extract surgical specimens 77,82 . Another assumption would be that the CO 2 used in abdominal insufflation or physical effects of pneumoperitoneum would cause reduced immunological function, thus, allowing tumor implantation in trocar wounds 39,66,70,[73][74][75]78,81,94 . However, implantations in abdominal wall, in laparotomy, have random and rare occurrences.…”