CANCER DISSEMINATION DURING LAPAROSCOPIC SURGERY - TUBES, GAS, AND CELLS

Port-site metastasis has been an unexpected finding after laparoscopic surgery in gastrointestinal cancer patients. No clear explanation exi sts for this phenomenom. The aims of this study were to evaluate the d issemination pattern in an experimental model of hepatocarcinoma in th e rat and summarize current knowledge about the risks and the results of experimental studies on cancer dissemination during laparoscopic su rgery. NDA-induced hepatocarcinoma was obtained in Sprague-Dawley rats , Tumors were manipulated during laparoscopy (group 1, n = 11) or lapa rotomy (group 2, n = 12). A Medline review of all experimental studies about the risk of cancer dissemination during laparoscopic surgery wa s undertaken. Both models were associated with implants in parietal wo unds [1/11 in group 1 (9%) vs. 1/12 in group 2 (8%), p = NS], Analysis of the current literature confirms that laparoscopy is associated wit h abdominal cell mobilization, and cells can be recovered in trocars, filtered exhaust gas, and instruments. Postoperative immunosuppression , the biologic aggressiveness of the tumor, and the gas used for lapar oscopy also influence tumoral growth, Port-site metastases are seconda ry to multiple factors, including the technical skill of the surgeon, the biologic properties of the tumors, and local environmental aspects , Undoubtedly, laparoscopy can help disseminate aggressive tumors and should be reserved for diagnostic and staging procedures or for treatm ent of low-grade malignant tumors, Therapeutic resection, especially o f colon cancer, should be restricted to prospective and randomized tri als until there are enough hard data to rule out the clinical importan ce of this potentially severe complication.