Influence of peritoneal factors on port‐site metastases in a xenograft ovarian cancer model

Abstract

Objective We determine the main physical effects of pneumoperitoneum on tumour dissemination and port-site metastases occurrence.Design A prospective randomised study in rats.Methods A human ovarian cancer cell line (IGR-OV1) was xenografted in nude rats. Seven days after cancer inoculation, surgery was performed. Rats were randomised in two main groups and underwent either: gasless laparoscopy (n 20) CO2 laparoscopy with pneumoperitoneum pressure at 4 mmHg (n 20), or 8 mmHg (n 20) with in each case, increasing operative duration: 30,60,90 or 120 minutes (®ve rats for each time). Animals were killed seven days after the intervention. Main outcome measures Tumour dissemination and frequency of port-site metastases.Results Tumour dissemination was not in¯uenced by gas pressures or duration of procedure. The rate of rats with at least one port-site metastasis (one or two) was similar in all groups: gasless: n 10/20; 4 mmHg CO2: 5/20; 8 mmHg CO2: 7/20,(P 0.26). The number of port-site metastases were signi®cantly higher in the gasless group compared with the 4 mmHg CO2 group (15/40 (37.5%) vs 5/40 (12.5%), P 0.01). Difference was not signi®cant between the 8mmHg group and the gasless group (9/40(22.5%) vs 15/40(37.5%), P 0.14) or the 4mmHg group (9/40(37.5%) vs 5/40 (12.5%), P 0.24). Duration of procedures had no signi®cant in¯uence on port-site metastases rate (P . 0.05). Conclusions Unlike previous animal studies, port-site metastases were more frequent with gasless laparoscopy than with CO2 pneumoperitoneum. Local peritoneal factors could play an important role in port-site metastases mechanism.

Influence of surgical trauma on tumor establishment in a rat ovarian cancer model

“…In in-vitro experiments, the SKOV3 ovarian carcinoma cell line was found to show increased growth under the influence of CO 2 [8]. By contrast, in various studies in which the nude rat model was used, neither the laparoscopy gas used nor laparoscopy itself was found to have any influence on various tumor parameters such as the weight of the omentum, metastases, survival of the animals or circulating tumor DNA, in comparison with laparotomy [5,9,10,11,12]. However, Canis et al [6] observed increased tumor growth after laparotomy in the BD IX rat model in comparison with animals that underwent laparoscopic procedures.…”

Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy

“…Several investigations have shown that a deficient supply of blood and oxygen in ascites provides favorable conditions for the growth and survival of tumor stem cells 3940. Indeed, the presence of malignant ascites during and after surgery has been reported to increase the risk of port-site metastasis 12. Another reason may be that tumor cells in the ascitic fluid flow easily into the port site during the B-ultrasound-guided or laparoscopically-assisted placement of catheters for HIPPC.…”

“…However, concerns have been raised in light of numerous case reports documenting port-site recurrences after diagnostic laparoscopy or laparoscopic resection in patients with malignancies,678910 and these concerns have limited the use of laparoscopic techniques for the resection of intra-abdominal malignancies. Therefore, further studies of the factors contributing to port-site metastasis are needed to overcome this serious problem 11121314…”

“…Another factor that may increase the risk of tumor growth at the trocar site is local tissue trauma 16303132. The traumatized trocar wound appears to be a good medium for the implantation and growth of tumor cells, due to the abundance of growth factors in the traumatized tissue 121316303132. However, the presence of free viable tumor cells in the peritoneal cavity and transportation of these cells to the trocar wounds is required, and these hypotheses remain controversial.…”

Video endoscopic surgery in the treatment of patients with early ovarian cancer

“…Подобные сведения инициировали проведение различных экспериментальных исследований, направ-ленных на изучение патогенеза этих явлений и подтвер-дивших на животных моделях обоснованность опасений специалистов, предопределив критическое и насторожен-ное отношение к видеоэндоскопической хирургии, со-храняющееся во многих онкологических школах и по сей день [6][7][8]. Тем не менее анализ накопленного к настоя-щему времени опыта позволяет более объективно оценить обсуждаемую проблему.…”