How to prevent port-site metastases in laparoscopic colorectal surgery

Various reports concerning port-site metastasis after laparoscopic surgery for colorectal cancer have created a new concern regarding the use of this technique for the treatment of this malignancy. The real incidence is not y et known; neither are its prognostic implications. Numerous experimental st udies, both in vitro and in vivo, have been published since 1994. These stu dies have analyzed the possible role of pneumoperitoneum and carbon dioxide (CO,) and pathophysiology, as well as the influence of minimally invasive techniques on tumor response and immunity. There are no definitive results yet, but there is enough evidence to presume that the etiology of this new complication might derive from surgical technique. We present our 8-year ex perience with laparoscopic surgery for colorectal cancer. We also review ou r technique for preventing port-site implants. At this writing, we have had no port metastasis in our series of 320 colorectal cancer cases with a mea n follow-up period of 54 months. The steps we follow as a routine in all ca ses of laparoscopic colorectal cancer are (a) fixation of trocars to the ab dominal wall, (b) avoidance of touching the tumor, (c) high vascular ligati on, (d) intraoperative colonoscopy and intraluminal irrigation with 5% iodi ne povidone, (e) specimen isolation before extraction from the abdominal ca vity, and (f) intraperitoneal and trocar-site irrigation with a tumoricide solution.