The effect of laparoscopy on the movement of tumor cells and metastasis to surgical wounds

Abstract

Carbon dioxide insufflation results in tumor dissemination during laparoscopy, leading to port site metastasis. Gasless laparoscopy may prevent this problem.

Port-site Metastasis after Minimally Invasive Surgery for Urological Malignancy: A Review of Literature

“…As suggested by few animal studies, the port-site incision is more conducive than the laparotomy incision for tumor seeding. 19 Aoki et al 20 suggest that repair of the peritoneum at the trocar entry site may reduce the risk of tumor implantation and subsequent recurrence. Immune depression of the peritoneum occurs during laparoscopic insufflation as demonstrated by macrophage function alteration, resulting in tumor recurrence and metastasis.…”

Absence of port-site metastases following staging laparoscopy for gastric carcinoma

“…A cytology sampling was obtained, which did not influence therapeutic decisions. Mean exploration time was 22 minutes (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). If the tumor was considered curable, the trocars were withdrawn and a laparotomy and radical gastrectomy were performed.…”

“…As a result, studies have been addressed concerning the influence of laparoscopy on tumor spreading and patient survival. They suggest a role for CO 2 diffusion (16)(17)(18)(19)(20)(21)(22), limited surgeon experience and consequent tumor handling (21,23), direct cell adhesion to ports (24), trocar material composition (25), and hematogenous spread (26,27). At present controversy persists.…”

Surgical Management of Metastatic Disease to the Adrenal Gland

“…35,37 There have been contradictory reports on the role of the pneumoperitoneum as the cause of port site metastasis and carcinomatosis. [38][39][40] In an novel study by Ikramuddin et al, carbon dioxide effluent recovered from patients with cancer during laparoscopy was examined. 40 The authors concluded that malignant cells are aerosolized in laparoscopic surgery, but in patients without carcinomatosis, aerosolization is unlikely to contribute to port site metastasis.…”