Adverse Impact of Pneumoperitoneum on Intraperitoneal Implantation and Growth of Tumour Cell Suspension in an Experimental Model

Abstract

Background: An investigation of the effect of laparoscopy and CO2 pneumoperitoneum on the pattern of tumour implantation and growth in the peritoneal cavity was carried out. Methods: A suspension of viable adenocarcinoma cells was introduced into the left upper quadrant of the peritoneal cavity of 36 syngeneic immune‐competent rats at laparotomy, laparoscopy with CO2 insufflation, and gasless laparoscopy (12 rats in each group). Six days later the peritoneal cavity and surgical wounds were examined for macroscopic evidence of implanted tumour. The abdominal cavity was divided into sectors and macroscopic tumour implantation was determined for each sector and wound. This was confirmed by histological examination. Results: While tumour implantation occurred in the vicinity of the tumour suspension introduction site in the laparotomy and gasless laparoscopy groups, implantation occurred throughout the peritoneal cavity, including areas remote to the introduction site, in the laparoscopy with CO2 insufflation group. Tumour growth was more likely in the port wounds of rats undergoing laparoscopy with insufflation than without. Conclusions: In this model, CO2 insufflation during laparoscopy resulted in widespread tumour dissemination and implantation, when compared to laparotomy and gasless laparoscopy, supporting the postulate that wound metastasis and tumour spread may be more likely following laparoscopic cancer surgery in humans when CO2 insufflation is used.

Exposure to carbon dioxide and helium reduces in vitro proliferation of pediatric tumor cells

“…Numerous experimental studies confirmed that CO 2 pneumoperitoneum alters the behavior of adult tumor cells derived from colon carcinoma, adenocarcinoma, and breast cancer [11,15,16]. The behavior of pediatric tumor cells has not been investigated in this respect in vitro.…”

A prospective study of minimally invasive techniques in pediatric surgical oncology: preliminary report

“…Studies in adult tumors show an increase in tumor dissemination after CO 2 insufflation [15,16], whereas there were no signs of an effect in neuroblastoma [17]. This and other potential influences of MIS on tumor growth and metastases need to be addressed.…”

Intraperitoneal macrophages and tumor immunity: A review

“…These investigations, however, do not report any data regarding host tumor interaction in the peritoneal cavity. Another common design flaw involves the intraperitoneal administration of neoplasms that do not reside in the peritoneal cavity, such as mammary carcinoma, or neuroblastoma [122][123][124]. Unfortunately, these transplanted tumors do not demonstrate the same tissue tropism, making data interpretation open to criticism.…”