TROCAR SITE TUMOR RECURRENCES - MAY PNEUMOPERITONEUM BE RESPONSIBLE

Background: Port site metastasis following laparoscopy for cancer is r eported with increasing frequency and represents one of the most impor tant limitations of the technique. Methods: A scintigraphic model was utilized to evaluate a possible role of pneumoperitoneum in tumor cell dissemination. Labeled red blood cells (RBC) were injected at the lev el of the gallbladder bed during laparoscopic cholecystectomy (LC) per formed for symptomatic cholecystolithiasis. LC was performed in two gr oups with standard CO2 pneumoperitoneum: in one group an endobag for r etrieval of the specimen was utilized. In one group a gasless LC with endobag was performed. Results: Radioactivity in the area of the troca r introduction was observed in almost all the patients who underwent s tandard (CO2) LC but represented a rare event in patients treated with the gasless method. The utilization of a protective bag for the extra ction of the surgical specimen did not modify significantly the result s. Moreover all patients treated with pneumoperitoneum demonstrated a wide intraperitoneal diffusion of the tracer not observed in gasless p atients. Conclusions: The results of this study confirm that pneumoper itoneum may play an important role in the evolution of port site metas tasis after laparoscopy for gastrointestinal cancer.