Does carbon dioxide pneumoperitoneum enhance wound metastases following laparoscopic abdominal tumor surgery? A meta-analysis of 20 randomized control studies

Abstract

The mechanisms involved in the development of wound metastasis following laparoscopic abdominal tumor surgery remain unclear. The aim of this study was to accurately assess whether the duration of carbon dioxide pneumoperitoneum (CDP) during laparoscopic abdominal tumor surgery enhances wound metastases. We conducted a systematic review of PubMed, Cochrane Library, and Embase through December 2013 to identify animal experiments comparing wound recurrence between laparoscopic and gasless laparoscopic procedures or open procedures. The outcome of interest was the number of animals with a wound tumor. Meta-regression was used to assess whether heterogeneity was explained by study level covariates (animal model, study size, CDP pressure, duration, and evaluated time). Twenty randomized control studies involving 1,229 animals were included. Wound recurrence was not significant in the laparoscopic surgery (LP) vs. gasless laparoscopic surgery (GLP) subgroups [odds ratio (OR), 2.23; 95 % confidence interval (CI), 0.90–5.55; P = 0.08) or the LP vs. laparotomy (LA) subgroups (OR, 0.97; 95 % CI, 0.31–3.00; P = 0.08). Overall postoperative wound recurrence results were not significantly different between the study groups and controls (OR, 1.47; 95 % CI, 0.74–2.92; P = 0.28). A meta-regression analysis showed that the outcome was not correlated with the covariates (animal model: P = 0.82; evaluated time: P = 0.30; pressure of CDP: P = 0.12; duration time: P = 0.80). Current evidence suggests that CDP does not enhance wound metastases following laparoscopic abdominal tumor surgery. Additional large sample, well-designed, randomized, controlled trials are needed to further confirm whether CDP duration in laparoscopic abdominal tumor surgery significantly enhances wound recurrence.

Port-Site Metastasis in Gynecological Malignancies

“…[17][18][19][20] In 2014, a meta-analysis including 20 randomized control trials using animal models found that wound recurrence was not significantly higher in laparoscopic surgery compared to gasless laparoscopy (odds ratio [OR] 2.23; 95% confidence interval [CI], 0.90 -5.55; P = .08) or laparotomy (OR, 0.97; 95% CI, 0.031 -3.00; P = .08). 21 Furthermore, surgical technique and repeated reintroduction of trocars have also been proposed in the development of PSM. 10,17 The latter may lead to trauma and exposure to malignant cells, rendering the surrounding tissue susceptible to tumor implantation.…”

Revisiting Minimally Invasive Surgery in the Management of Early-Stage Cervical Cancer

“…Animal studies exploring the role of CO 2 gas in possible tumor spread have been conflicting; some have suggested that CO 2 pneumoperitoneum may increase wound and peritoneal metastases compared with laparotomy or gasless laparoscopy, [20][21][22] although other studies have failed to demonstrate a difference. 23,24 An additional consideration is whether the extent of resection differs between minimally invasive and open surgical approaches for radical hysterectomy. One single-institution study suggested that robotic surgery was associated with a higher rate of close surgical margins compared with open surgery, although only 20 cases were robotic and may have been performed during the robotic surgery learning curve.…”

Comment on "Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation"

“…This is not sufficient to be a causative factor for xenograft implantation and angiogenesis induction. Moreover, an impact of CO2 insufflation itself on tumor cell implantation is under debate [ 3 ]. Therefore, it seems to be more suitable to call this model as “Morcellation-induced parasitic myomas”.…”