Intraperitoneal hypothermia during surgery enhances postoperative tumor growth

Abstract

These data demonstrate that the peritoneal insufflation of CO2 enhances tumor growth and that the prevention of perioperative hypothermia during laparoscopy attenuates tumor growth. This effect may be partially mediated by the increased peritoneal trauma that results from insufflation with cold gas.

Peritoneal pH during laparoscopy is dependent on ambient gas environment: helium and nitrous oxide do not cause peritoneal acidosis

“…Its wide use in laparoscopic surgery, and especially in oncologic procedures, began to raise concern after reports of a higher rate of tumor growth with CO 2 laparoscopy [5,7,9]. Volz et al have proposed that peritoneal acidosis during CO 2 laparoscopy may be one of the mechanisms responsible for damaging the mesothelial lining of the peritoneum and thereby exposing the underlying basal lamina [17].…”

“…Whether the use of the visceral peritoneum, with its transient and less extreme pH changes, will translate into less peritoneal damage is not known. It is, however, interesting to note that most studies of peritoneal recurrence after laparoscopic procedure have concentrated on the parietal peritoneum [7,9,11,17,18].…”

“…Intracellular and extracellular pH are also important regulators of cell functions such as adenosine triphosphate (ATP) production, cell cycle, cell growth, and apoptosis [18]. It is therefore plausible that the increased tumor growth seen after CO 2 laparoscopy in some studies [5,7,9] is a consequence of the peritoneal acidosis caused by CO 2 . In this series of experiments, we examined the relative contributions of the effects of the ambient gas …”

Internal environment in cancer patients and proposal that carcinogenesis is adaptive response of glycolysis to overcome adverse internal conditions

“…* p < 0.05, ** p < 0.01. lymphocytopenia, were also present. Although clinicians are empirically aware of the deteriorated conditions such as hypoxia, immunosuppression and anemia in cancer patients [13][14][15][16][17][18][19][20], as shown by a review of the literature, few studies have been done on the simultaneous identification of all these conditions. We propose the possibility that hypothermia, hypoxia and hyperglycemia are beneficial for stress-exposed persons to escape from emergencies inducing stress for short periods of time, but that such internal environment might become cancer-inducing over a longer period of time.…”

Péritoine et endoscopie : la révolution est devant nous !

“…L'humidification du gaz prévient l'hypothermie des patients et on sait que l'hypothermie aggrave la croissance tumorale postopératoire [19,20]. Après coelioscopie au CO 2 , la formation d'adhé-rence dépend de la durée de l'intervention et de la pression que l'on utilise et, les adhérences postopératoires peuvent être diminuées en ajoutant de l'oxygène au CO 2 à des concentrations de 3 à 4 % [21,22].…”