Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1996 Dec;224(6):694–701. doi: 10.1097/00000658-199612000-00005

Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases.

N D Bouvy 1, R L Marquet 1, H Jeekel 1, H J Bonjer 1
PMCID: PMC1235462  PMID: 8968224

Abstract

OBJECTIVE: A tumor model in the rat was used to study peritoneal tumor growth and abdominal wall metastases after carbon dioxide (CO2) pneumoperitoneum, gasless laparoscopy, and laparotomy. SUMMARY BACKGROUND DATA: The role of laparoscopic resection of cancer is under debate. Insufflation of the peritoneal cavity with CO2 is believed to be a causative factor in the development of abdominal wall metastases after laparoscopic resection of malignant tumors. METHODS: In the solid tumor model, a lump of 350-mg CC-531 tumor cells was placed intraperitoneally in rats having CO2 pneumoperitoneum (n = 8), gasless laparoscopy (n = 8), or conventional laparotomy (n = 8). After 20 minutes, the solid tumor was removed through a laparoscopic port or through the laparotomy. In the cell seeding model, 5 x 10(5) CC-531 cells were injected intraperitoneally before CO2 pneumoperitoneum (n = 12), gasless laparoscopy (n = 12), or laparotomy (n = 12). All operative procedures lasted 20 minutes. After 6 weeks, in the solid tumor model and after 4 weeks in the cell seeding model, tumor growth was scored semiquantitatively. All results were analyzed using the analysis of variance. RESULTS: In the solid tumor model, peritoneal tumor growth in the laparotomy group was greater than in the CO2 pneumoperitoneum group (p < 0.01). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p < 0.01). The size of abdominal wall metastases was greater at the port site of extraction of the tumor than at the other port sites (p < 0.001). In the cell seeding model, peritoneal tumor growth was greater after laparotomy in comparison to CO2 pneumoperitoneum (p < 0.02). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p < 0.01). The port site metastases in the CO2 group were greater than in the gasless group (p < 0.01). CONCLUSIONS: The following conclusions can be made: 1) that direct contact between solid tumor and the port site enhances local tumor growth, 2) that laparoscopy is associated with less intraperitoneal tumor growth than laparotomy, and 3) that insufflation of CO2 promotes tumor growth at the peritoneum and is associated with greater abdominal wall metastases than gasless laparoscopy.

Full text

PDF
694

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allendorf J. D., Bessler M., Kayton M. L., Oesterling S. D., Treat M. R., Nowygrod R., Whelan R. L. Increased tumor establishment and growth after laparotomy vs laparoscopy in a murine model. Arch Surg. 1995 Jun;130(6):649–653. doi: 10.1001/archsurg.1995.01430060087016. [DOI] [PubMed] [Google Scholar]
  2. Beart R. W., Jr Laparoscopic colectomy: status of the art. Dis Colon Rectum. 1994 Feb;37(2 Suppl):S47–S49. doi: 10.1007/BF02048431. [DOI] [PubMed] [Google Scholar]
  3. Botoman V. A., Pietro M., Thirlby R. C. Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum. 1994 Aug;37(8):775–776. doi: 10.1007/BF02050141. [DOI] [PubMed] [Google Scholar]
  4. Bouvy N. D., Marquet R. L., Hamming J. F., Jeekel J., Bonjer H. J. Laparoscopic surgery in the rat. Beneficial effect on body weight and tumor take. Surg Endosc. 1996 May;10(5):490–494. doi: 10.1007/s004649910096. [DOI] [PubMed] [Google Scholar]
  5. Cirocco W. C., Schwartzman A., Golub R. W. Abdominal wall recurrence after laparoscopic colectomy for colon cancer. Surgery. 1994 Nov;116(5):842–846. [PubMed] [Google Scholar]
  6. Dubois F., Icard P., Berthelot G., Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990 Jan;211(1):60–62. doi: 10.1097/00000658-199001000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Eggermont A. M., Steller E. P., Marquet R. L., Jeekel J., Sugarbaker P. H. Local regional promotion of tumor growth after abdominal surgery is dominant over immunotherapy with interleukin-2 and lymphokine activated killer cells. Cancer Detect Prev. 1988;12(1-6):421–429. [PubMed] [Google Scholar]
  8. Frazee R. C., Roberts J. W., Symmonds R. E., Snyder S. K., Hendricks J. C., Smith R. W., Custer M. D., 3rd, Harrison J. B. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg. 1994 Jun;219(6):725–731. doi: 10.1097/00000658-199406000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Glerup H., Heindorff H., Flyvbjerg A., Jensen S. L., Vilstrup H. Elective laparoscopic cholecystectomy nearly abolishes the postoperative hepatic catabolic stress response. Ann Surg. 1995 Mar;221(3):214–219. doi: 10.1097/00000658-199503000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Griffith J. P., Everitt N. J., Lancaster F., Boylston A., Richards S. J., Scott C. S., Benson E. A., Sue-Ling H. M., McMahon M. J. Influence of laparoscopic and conventional cholecystectomy upon cell-mediated immunity. Br J Surg. 1995 May;82(5):677–680. doi: 10.1002/bjs.1800820539. [DOI] [PubMed] [Google Scholar]
  11. Hoffman G. C., Baker J. W., Fitchett C. W., Vansant J. H. Laparoscopic-assisted colectomy. Initial experience. Ann Surg. 1994 Jun;219(6):732–743. doi: 10.1097/00000658-199406000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Holzman M., Sharp K., Richards W. Hypercarbia during carbon dioxide gas insufflation for therapeutic laparoscopy: a note of caution. Surg Laparosc Endosc. 1992 Mar;2(1):11–14. [PubMed] [Google Scholar]
  13. Hughes E. S., McDermott F. T., Polglase A. L., Johnson W. R. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery. Dis Colon Rectum. 1983 Sep;26(9):571–572. doi: 10.1007/BF02552962. [DOI] [PubMed] [Google Scholar]
  14. Jones D. B., Guo L. W., Reinhard M. K., Soper N. J., Philpott G. W., Connett J., Fleshman J. W. Impact of pneumoperitoneum on trocar site implantation of colon cancer in hamster model. Dis Colon Rectum. 1995 Nov;38(11):1182–1188. doi: 10.1007/BF02048334. [DOI] [PubMed] [Google Scholar]
  15. Juhl H., Stritzel M., Wroblewski A., Henne-Bruns D., Kremer B., Schmiegel W., Neumaier M., Wagener C., Schreiber H. W., Kalthoff H. Immunocytological detection of micrometastatic cells: comparative evaluation of findings in the peritoneal cavity and the bone marrow of gastric, colorectal and pancreatic cancer patients. Int J Cancer. 1994 May 1;57(3):330–335. doi: 10.1002/ijc.2910570307. [DOI] [PubMed] [Google Scholar]
  16. Kazemier G., Bonjer H. J., Berends F. J., Lange J. F. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg. 1995 Aug;82(8):1141–1142. doi: 10.1002/bjs.1800820850. [DOI] [PubMed] [Google Scholar]
  17. Minoli G., Terruzzi V., Tadeo G. Laparoscopy: the question of the proper gas. Gastrointest Endosc. 1983 Nov;29(4):325–325. doi: 10.1016/s0016-5107(83)72650-7. [DOI] [PubMed] [Google Scholar]
  18. Murphy P., Alexander P., Senior P. V., Fleming J., Kirkham N., Taylor I. Mechanisms of organ selective tumour growth by bloodborne cancer cells. Br J Cancer. 1988 Jan;57(1):19–31. doi: 10.1038/bjc.1988.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. O'Rourke N., Price P. M., Kelly S., Sikora K. Tumour inoculation during laparoscopy. Lancet. 1993 Aug 7;342(8867):368–368. [PubMed] [Google Scholar]
  20. PREHN R. T., MAIN J. M. Immunity to methylcholanthrene-induced sarcomas. J Natl Cancer Inst. 1957 Jun;18(6):769–778. [PubMed] [Google Scholar]
  21. Phillips E. H., Franklin M., Carroll B. J., Fallas M. J., Ramos R., Rosenthal D. Laparoscopic colectomy. Ann Surg. 1992 Dec;216(6):703–707. doi: 10.1097/00000658-199212000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Ramos J. M., Beart R. W., Jr, Goes R., Ortega A. E., Schlinkert R. T. Role of laparoscopy in colorectal surgery. A prospective evaluation of 200 cases. Dis Colon Rectum. 1995 May;38(5):494–501. doi: 10.1007/BF02148849. [DOI] [PubMed] [Google Scholar]
  23. Savalgi RS. Mechanism of Abdominal Wall Recurrence After Laparoscopic Resection of Colonic Cancers. Semin Laparosc Surg. 1995 Sep;2(3):158–162. doi: 10.1053/SLAS00200158. [DOI] [PubMed] [Google Scholar]
  24. Watson R. W., Redmond H. P., McCarthy J., Burke P. E., Bouchier-Hayes D. Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model. Br J Surg. 1995 Aug;82(8):1060–1065. doi: 10.1002/bjs.1800820820. [DOI] [PubMed] [Google Scholar]
  25. Wexner S. D., Cohen S. M. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg. 1995 Mar;82(3):295–298. doi: 10.1002/bjs.1800820305. [DOI] [PubMed] [Google Scholar]
  26. Zirngibl H., Husemann B., Hermanek P. Intraoperative spillage of tumor cells in surgery for rectal cancer. Dis Colon Rectum. 1990 Jul;33(7):610–614. doi: 10.1007/BF02052218. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES