Mechanism for port-site metastasis after laparoscopic cancer surgery

Effects of Topical Tumoricidal Agents on Port-Site Recurrence of Colon Cancer: An Experimental Study in Rats

“…Published work on the role of pneumoperitoneum is controversial. 14,16,17,[27][28][29][30][31] We have demonstrated in our laboratory that these implantations probably are not hematogenous. 26 Several authors have come to the conclusion that trocar-site metastasis is the result of direct seeding of tumor cells into a susceptible wound.…”

Trocar site tumor recurrences

“…In these cases, malignant cells can desquamate during the operation: During the manipulation of the resected specimen into the bag, resting on the exterior surface of the bag, these cells could implant themselves while passing through the umbilical trocar site. Another possibility is that after deflation the abdominal wall sags down, allowing the exfoliated tumor cells in the peritoneal fluid to be implanted into the undersurface of the port wound where mesothelial cells are damaged or missing [11]. All this can explain the cases of positivity at the level of umbilical trocar site observed in groups B and C despite the utilization of a cellophane bag, yet it is not able to explain the significantly higher positivity in patients who had gas cholecystectomy compared to patients having gasless cholecystectomy.…”

Wound Recurrences Following Laparoscopic-Assisted Colectomy for Cancer

“…Only sporadically has tumor cell implantation been encountered on the camera and port-site wounds at the time of LAC for cancer. 81 On the other hand, benign cells have been demonstrated as aerosolized particles retrievable in the smoke generated during LAC. 82 When CO 2 effluent was examined in 35 patients, including 20 benign cases and 5 cases of peritoneal carcinomatosis out of 15 noncolorectal malignant neoplasms, malignant cells were found in only 2 patients with peritoneal carcinomatosis, and benign mesothelial cells were encountered in 2 patients with no cases of aerosolized tumor cells identified.…”