Laparoscopic excision of ovarian neoplasms subsequently found to be malignant

Maiman, Mitchell; Seltzer, Vicki; Boyce, John

doi:10.1016/0090-8258(91)90121-k

Cited by 97 publications

(52 citation statements)

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“…If tumour cells are inoculated into the trocar tracts during surgery, but tumouricidal therapy is delivered to the area, port‐site recurrences will also rarely develop; but if therapy is withheld, tumour growth will be accelerated. This explains the rapidity with which tumour can grow at trocar sites in women with ovarian cancer who are subjected to diagnostic laparoscopy if treatment is delayed 21–23 , and the paradoxical rarity of trocar site recurrences after definitive laparoscopic treatment of ovarian malignancies 24 , because women with ovarian cancer usually receive chemotherapy in the immediate post‐operative period.…”

Section: Discussionmentioning

confidence: 99%

“…Port‐site recurrences following laparoscopic surgery for gastrointestinal malignancies, particularly colorectal cancer, have been reported with increasing frequency 1 20 . Although rarely reported after definitive laparoscopic management of gynaecological cancers, many cases of port‐site recurrence have been reported following diagnostic laparoscopy in ovarian cancer 21–23 . These reports have raised the disturbing possibility that laparoscopic operations that by traditional surgical and pathological criteria allow satisfactory removal of malignant tumours may nonetheless compromise survival by creating a surgical environment that promotes tumour growth and dissemination.…”

Section: Introductionmentioning

confidence: 99%

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Port‐site recurrences following laparoscopic operations for gynaecological malignancies

Kadar

1997

BJOG

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Objective To determine the frequency of port-site recurrences following laparoscopic surgical treatment Design Retrospective review of metastatic primary and recurrent gynaecological malignancies.Results Twenty-five women were studied. Twenty-four had metastatic disease at the time of laparoscopic surgery, 22 in association with a primary malignancy (cervix: n = 12, ovary: n = 7, endometrium: n = 3), and two in association with recurrent ovarian cancer; all received pelvic or extended field radiation or chemotherapy after surgery. One woman with Stage IIIC ovarian cancer, disease-free at the completion of neoadjuvant chemotherapy following laparotomy by a general surgeon, was included; she developed scalene node metastases 18 months after definitive laparoscopic surgery. Seventy-one 5 mm trocars and fifty 10 mm trocars (total n = 121) were used for surgery; thirty-one 10 mm trocar sites and forty-four 5 mm sites (total n = 75) received post-operative treatment with chemotherapy (n = 49) or radiation (n = 26). Four women (16%) developed recurrences in association with endometrial (n = 2) and cervical (n = 2) cancer at six trocar sites. All recurrences were associated with abdominopelvic andlor distant metastases, and all occurred at untreated 5 mm trocar sites. The difference in recurrence rates between 5 mm and 10 mm trocar sites (x2 = 6; P < 0.025), and between treated and untreated trocars (x2 = 5 ; P < 0.05) were both statistically significant (McNemar's test), but the effects of treatment and trocar size on the port-site recurrence rate were confounded.Conclusions Port-site recurrences are local manifestations of disseminated disease that result from the enhancement of tumour growth characteristic of healing tissues and can be prevented by appropriate post-operative therapy.of gynaecological malignancies metastatic at the time of surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Port‐site recurrences following laparoscopic operations for gynaecological malignancies

Kadar

1997

BJOG

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“…Initial animal studies showed that CO2 pneumoperitoneum increased risk of port‐site metastasis compared with gasless laparoscopy 3–6 , but recent study is contradictory 7 . In gynaecology, port‐site metastasis has been mostly reported after laparoscopic treatment of ovarian neoplasms 8–11 . However, few experimental studies have used ovarian carcinoma cell lines 12 and most were carried out with colonic cancer models.…”

Section: Introductionmentioning

confidence: 99%

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

Agostini

Robin

Aggerbeck

et al. 2001

BJOG

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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.

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“…Because of the technical difficulty of the trocar insertion and specimen retrieval as well as poor visualisation, conventional laparotomy is still the mode of treatment for most patients with large ovarian cysts. Previous authors have suggested that ovarian masses of >10 cm are best managed by laparotomy, but for smaller specimens <10 cm, retrieval through the transumbilical port, with or without endoscopic bags, has been advocated on the basis that this site represents the thinnest and most distensible portion of the anterior abdominal wall . For simple cysts, which can be decompressed, this technique may be possible, but solid or semi‐solid ovarian tumours (such as dermoid cysts and fibromas) may prove more challenging …”

Section: Introductionmentioning

confidence: 99%

Methods for specimen removal from the peritoneal cavity after laparoscopic excision

Stavroulis

Memtsa

Yoong

2013

The Obstetric & Gynaecologis

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Laparoscopic excision of ovarian neoplasms subsequently found to be malignant

Cited by 97 publications

References 0 publications

Port‐site recurrences following laparoscopic operations for gynaecological malignancies

Port‐site recurrences following laparoscopic operations for gynaecological malignancies

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

Methods for specimen removal from the peritoneal cavity after laparoscopic excision

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