Oncologic implications of laparoscopic and open surgery

Abstract

Although instrumental manipulation and mechanical tumor cell spillage seem to play the major role in port-site metastases from laparoscopic cancer surgery, minimally invasive procedures are used more and more in the resection of malignancies. However, port-site metastases also have been reported after resection of colon cancer in International Union Against Cancer (UICC) stage I [2, 14]. Therefore, changes in the peritoneal environment during laparoscopy also might influence intra- and extraperitoneal tumor growth during laparoscopy and pneumoperitoneum. Different results of experimental studies presented at the Third International Conference for Laparoscopic Surgery are analyzed and discussed.

The effects of staging laparoscopy on trocar site and peritoneal recurrence of pancreatic cancer

“…Several experiments have been carried out looking at the type of insufflation used [9], physical manipulation of the tumor [7,9], aerolization of tumor cells [10], increased tumor invasiveness [13], and adherence of tumor cells to the disrupted peritoneum at the trocar sites [8].…”

“…A report from 1998 has documented 160 port-site recurrences after laparoscopy [14]. Other investigators reported experimental studies trying to elucidate the potential mechanisms of this phenomenon [9]. In addition, there are also experimental data suggesting that laparoscopy increases the invasive capacity of pancreatic cancer cells [13].…”

Morphology of the rat peritoneum after carbon dioxide and helium pneumoperitoneum: a scanning electron microscopic study

“…The most important mechanism in the pathogenesis of wound metastases seems to be instrumental manipulation of the tumor and mechanical spillage of tumor cells [8]. Nevertheless, there is evidence to suggest that carbon dioxide (CO 2 ) pneumoperitoneum (capnoperitoneum) creates conditions favorable to tumor growth.…”

Effect of carbon dioxide pneumoperitoneum on tissue blood flow in the peritoneum, rectus abdominis, and diaphragm muscles

“…Apparently technical skills and the learning curve have a major impact on the occurrence of the port-site metastasis [6]. However, some evidence from in vitro and in vivo studies suggests that CO 2 , the most commonly used gas during laparoscopic procedures, may interfere with host factors in a way that can promote the growth of malignant tumors [7].…”