Wound Recurrences Following Laparoscopic-Assisted Colectomy for Cancer

Abstract

To determine the incidence and clinical relevance of wound recurrences (WRs) following laparoscopic-assisted colectomy for cancer; to analyze the most recent experimental studies examining possible pathogenic mechanisms; and to delineate possible prevention strategies. Data Sources: A MEDLINE search was conducted using the words "colectomy," "laparoscopy," and "recurrence, local." Additional articles were retrieved by crossreferencing. Study Selection: All clinical and experimental studies retrieved were reviewed and subjectively selected according to their relevance for clinical practice. Data Extraction: Clinical data from 1990 to 2000 with series analyzing 50 or more patients were preferentially considered. Experimental data were considered based on the most rigorous study designs and the potential impact of experimental findings on clinical practice. Data Synthesis: The incidence of WRs in large series and based on current techniques is comparable to what has been reported for WR following open colectomy. While the pathogenesis of early WR occurrences remains unclear, experience and appropriate training in laparoscopic-assisted colectomy are essential to minimize the incidence of WRs. Results from experimental studies are still controversial, and available data from prospective randomized clinical trials are still limited. Conclusions: Results from prospective randomized trials are needed to provide definitive answers regarding the incidence and survival impact of WRs. Until then, WR may be considered a technical complication following laparoscopic-assisted colectomy.

Influence of pneumoperitoneum on tumor implantation in parietal incision: a comparative study of trocar incision and laparotomy in rats

“…It is believed that CO 2 promotes tumor cell growth, but in vitro studies have analyzed alterations caused by CO 2 in tumor growth and have demonstrated that it does not actually occur. The results suggest that CO 2 of at least 10 to 15 mmHg will cause a toxic effect 107 . Regarding the fact that videolaparoscopy may replace the conventional laparotomy access in the treatment of intra-abdominal tumors, the question remains very complex.…”

“…Through a review on current literature and sources such as SCIELO and LILACS, we can conclude that the use of videolaparoscopy as a proper oncological technique remains controversial, especially because most studies in this area are retrospective and only suggest conclusions, without conditions to be adopted as a support to practices, and prospective randomized studies are required to monitor patients for long postoperative periods, attesting the occurrence or non-occurrence of higher incidence of recurrence at trocar incision sites and lesion recurrence [107][108][109][110][111] .…”

Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective

“…A major problem that limits the broad acceptance of laparoscopic cancer surgeries is the significant skepti cism about LCS for cancer although laparoscopy is very popular in the treatment of many intra-abdominal disorders. The potential benefits of the laparoscopic technique must in fact be weighed against the potential for limited oncological outcomes due to inadequate resection, potential occurrence of port site metastases or metastatic spread [30][31][32] . Moreover, surgeons are fearful that laparoscopic surgery could be more harmful to cancer patients than open procedures [33] .…”

Minimal Access Cancer Management

“…Several case series, and even some registries, reported rates of trocar-site recurrences in excess of what was historically reported for open surgery. [78][79][80][81][82] This generated great interest in animal model investigations including mechanisms of tumor cell dissemination and immunologic studies. Clinical evidence was required to refute or confirm the association between the wound tumor implants and laparoscopic colectomy for cancer.…”