Cancer Dissemination during Laparoscopic Surgery: Tubes, Gas, and Cells

Abstract

Port-site metastasis has been an unexpected finding after laparoscopic surgery in gastrointestinal cancer patients. No clear explanation exists for this phenomenom. The aims of this study were to evaluate the dissemination pattern in an experimental model of hepatocarcinoma in the rat and summarize current knowledge about the risks and the results of experimental studies on cancer dissemination during laparoscopic surgery. NDA-induced hepatocarcinoma was obtained in Sprague-Dawley rats. Tumors were manipulated during laparoscopy (group 1, n = 11) or laparotomy (group 2, n = 12). A Medline review of all experimental studies about the risk of cancer dissemination during laparoscopic surgery was undertaken. Both models were associated with implants in parietal wounds [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 with 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 laparoscopy also influence tumoral growth. Port-site metastases are secondary 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 treatment of low-grade malignant tumors. Therapeutic resection, especially of colon cancer, should be restricted to prospective and randomized trials until there are enough hard data to rule out the clinical importance of this potentially severe complication.

Port site metastases after laparoscopic cholecystectomy for an unexpected gallbladder carcinoma

“…This case shows that removal of unsuspected gallbladder carcinoma by the laparoscopic technique can produce one of these unusual complications: [3]. Similar proportions could be expected if cholecystectomies by these two different procedures were compared [2,4].…”

Port Site Recurrences after Laparoscopic Surgery

“…Most metastases occurred in patients with advanced disease but an increasing number were found after operations for T1 and T2 gallbladder cancers as well as Duke’s A and B colorectal cancers. In this clinical situation numerous editorials and reviews have concluded that laparoscopic surgery for cancer should not be performed outside controlled studies until there are enough data about the clinical importance of this complication [82]. The preliminary data of the CAE port site registry (Workgroup Surgical Endoscopy) seem to comfirm such concerns.…”

Peritoneal Carcinomatosis following Laparoscopic Resection of an Adrenocortical Tumor Causing Primary Hyperaldosteronism

“…The possible contribution of laparoscopic surgery to the dissemination of the tumor, although not proven, needs to be discussed. Metastases of an adrenocortical tumor occurring soon after laparoscopic surgery have rarely been reported up to now, but serious concern has recently been raised among surgeons regarding the suitability of laparoscopy for resection of malignant tumors [7, 8], even though laparoscopic surgery induces less trauma and immunosuppression than open surgery [9, 10]. Large tumors are usually not removed by laparoscopy because of their potential malignancy but the cut-off size is usually considered to be around 5 cm [11].…”