Advertisement

Diseases of the Colon & Rectum

, Volume 40, Issue 8, pp 939–945 | Cite as

Operative factors affecting tumor cell distribution following laparoscopic colectomy in a porcine model

  • Randall A. Allardyce
  • Phil Morreau
  • Philip F. Bagshaw
Original Contributions

Abstract

BACKGROUND: An increased risk of laparoscopic port wound tumor implantation in the presence of overt or covert abdominal malignancy has been identified. PURPOSE: A porcine laparoscopic colectomy model has been used to quantify the influence surgical practices may have on tumor cell implantation. METHODS:51Cr-labeled, fixed HeLa cells were injected intraperitoneally before surgery. Tumor cell contamination of instruments, ports, security threads, and excised wound margins was assessed by gamma counting. RESULTS: Greatest contamination occurred in ports used by the operating surgeon under pneumoperitoneum (64 percent of all port wound tumor cells) and mechanical elevation (76 percent). Gasless surgery in patients in the head-down position increased the rostral accumulation of tumor cells in the abdomen and right upper quadrant port wound by 330 and 176 percent, respectively. Under pneumoperitoneum, port movement was the major contributor to port leakage and wound contamination (21 percent of total recovered wound tumor cells per port). Tumor cells were not carried in aerosol form. Instrument passage and the withdrawal of security threads through the abdominal wall increased port wound contamination 430 and 263 percent, respectively, over pneumoperitoneum control ports. Preoperative lavage reduced by 61 percent, but did not eliminate, wound contamination. CONCLUSION: This porcine model may be used to evaluate surgical factors for the impact on port wound contamination.

Key words

Laparoscopy Port site implants Colectomy Complications Pneumoperitoneum 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Beart RW Jr. Laparoscopic colectomy: status of the art. Dis Colon Rectum 1994;37(Suppl):S47–9.PubMedGoogle Scholar
  2. 2.
    Nduka CC, Monson JR, Menzies-Gow N, Darzi A. Abdominal wall metastases following laparoscopy. Br J Surg 1994;81:648–52.PubMedGoogle Scholar
  3. 3.
    Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995;82:295–8.PubMedGoogle Scholar
  4. 4.
    Savalgi RS. Mechanism of abdominal wall recurrence after laparoscopic resection of colonic cancers. Semin Laparosc Surg 1995;2:158–62.PubMedGoogle Scholar
  5. 5.
    Greene FL. Principles of cancer biology in relation to minimal access surgical techniques. Semin Laparosc Surg 1995;2:155–7.PubMedGoogle Scholar
  6. 6.
    Skipper D, Cooper AJ, Marston JE, Taylor I. Exfoliated cells andin vitro growth in colorectal cancer. Br J Surg 1987;74:1049–62.PubMedGoogle Scholar
  7. 7.
    Murthy SM, Goldschmidt RA, Rao LN. The influence of surgical trauma on experimental metastasis. Cancer 1989;64:2035–44.PubMedGoogle Scholar
  8. 8.
    Jones DB, Guo L-W, Reinhard MK,et al. Impact of pneumoperitoneum on trocar site implantation of colon cancer in hamster model. Dis Colon Rectum 1995;38:1182–8.PubMedGoogle Scholar
  9. 9.
    Hansen E, Wolff N, Knuechel R, Ruschoff J, Hofstaedter F, Taeger K. Tumor cells in blood shed from the surgical field. Arch Surg 1995;1340:387–93.Google Scholar
  10. 10.
    Allardyce R, Morreau P, Bagshaw P. Tumor cell distribution following laparoscopic colectomy in a porcine model. Dis Colon Rectum 1996;39(Suppl):S47–52.PubMedGoogle Scholar
  11. 11.
    Hughes ES, McDermott FT, Polglase AL, Johnson WR. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery. Dis Colon Rectum 1983;26:571–2.PubMedGoogle Scholar
  12. 12.
    Brodsky JT, Cohen AM. Peritoneal seeding following potentially curative resection of colonic carcinoma: implications for adjuvant therapy. Dis Colon Rectum 1991;34:723–7.PubMedGoogle Scholar
  13. 13.
    Thomas WM, Eaton MC, Hewett PJ. A proposed model for the movement of cells within the abdominal cavity during CO2 insufflation and laparoscopy. Aust N 2 J Surg 1996;66:105–6.Google Scholar
  14. 14.
    Fleshman JW, Nelson H, Peters WR,et al. Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 1996;39(Suppl):S53–8.CrossRefPubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1997

Authors and Affiliations

  • Randall A. Allardyce
    • 1
  • Phil Morreau
    • 1
  • Philip F. Bagshaw
    • 1
  1. 1.Department of SurgeryChristchurch School of MedicineChristchurchNew Zealand

Personalised recommendations