Efficacy of surgical measures in preventing port-site recurrences in a porcine model
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- Schneider, C., Jung, A., Reymond, M.A. et al. Surg Endosc (2001) 15: 121. doi:10.1007/s004640010069
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Port-site recurrences are serious complications of laparoscopy performed for cancer. Incidences reported in the literature vary between 0% and 21%, suggesting an influence of the surgeon.
The aim of this experimental, prospective, randomized, single-blind study was to investigate the influence that the quality surgery has on the incidence of port-site recurrences. After a 12-mmHg carbon dioxide (CO2) pneumoperitoneum was created, 107 human HeLa cell were injected into the peritoneal cavity of 18 pigs, creating a xenogeneic tumor. Laparoscopic sigmoid resections then were performed using four trocars and a transanal double-stapling technique. The following protective measures were applied in nine animals: trocar fixation, prevention of gas leaks, rinsing of instruments with povidone-iodine, minilaparotomy protection, rinsing of trocars before removal, peritoneal closure, and rinsing of all wounds with povidoneiodine. Surgeons and type of procedures were randomized. After 4 weeks, the animals were killed and all portsites excised. Blinded immunohistologic analysis with antihuman pancytokeratin antibody was performed.
Tumor recurrence was present in 23 of 36 port sites (63.8%) in the control group, but only in 5 of 36 port sites (13.8%) in the group that received protective measures (p=0.002; Fisher’s exact test). No peritoneal carcinosis nor anastomotic recurrences were observed.
These results strongly suggest that the quality of surgical technique has an influence on the incidence of port-site recurrences. From now on, we propose to use these protective measures reoutinely in cancer laparoscopy.