Diseases of the Colon & Rectum

, Volume 41, Issue 2, pp 141–146 | Cite as

Effects of pneumoperitoneum on tumor implantation with decreasing tumor inoculum

  • Justin S. Wu
  • Daniel B. Jones
  • Li-Wu Guo
  • Earl B. Brasfield
  • Martha B. Ruiz
  • Judith M. Connett
  • James W. Fleshman
Original Contributions
  • 14 Downloads

Abstract

INTRODUCTION: The aim of this study was to determine the effect of pneumoperitoneum on the rate of trocar-site implantation with decreasing inoculum of cancer cells. METHODS: A total of 0.5 ml of GW-39 human colon cancer cell suspensions at 1 percent (∼3.2×105 cells) and at 0.5 percent (∼1.6×105 cells; v/v) were injected into the abdomen of hamsters through a midline incision. Animals in each group were randomized to receive either pneumoperitoneum (1 percent=33; 0.5 percent=43) or not (1 percent=32; 0.5 percent=39). Gross and microscopic tumor implants were documented seven weeks later at four trocar sites. RESULTS: In the 1 percent group, pneumoperitoneum significantly increased trocar-site tumor implants from 50 to 71 percent (P<0.001). Pneumoperitoneum also resulted in the following: 1) more frequent involvement of all four concurrent sites (38vs. 10 percent;P<0.02); 2) more frequent palpable tumors (13vs. 5 percent;P<0.01); 3) larger tumor mass (2.1±0.6 gvs. 0.2±0.1 g;P<0.02). In the 0.5 percent group, pneumoperitoneum did not significantly increase trocar-site tumor implants, and it did not result in a larger tumor mass. The percent increase in trocar-site implants owing to pneumoperitoneum was influenced by the amount of tumor inoculum (21 percent in the 1 percent group; 10 percent in the 0.5 percent group). The mass of palpable tumor implants after pneumoperitoneum decreased with decreased inoculum: 1 percent =2.1±0.6 g; 0.5 percent=0.3±0.1 g (P<0.0001). CONCLUSIONS: Pneumoperitoneum significantly increased both tumor implantation rate and mass when ∼3.2×105 colon cancer cells were injected into the peritoneal cavity. These effects of pneumoperitoneum diminished with one-half as many tumor cells injected in the peritoneal cavity.

Key words

Tumor Implants Trocar Port Recurrence Colon cancer Colectomy Laparoscopy Pneumoperitoneum 

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Copyright information

© the American Society of Colon and Rectal Surgeons 1998

Authors and Affiliations

  • Justin S. Wu
    • 1
  • Daniel B. Jones
    • 1
  • Li-Wu Guo
    • 1
  • Earl B. Brasfield
    • 1
  • Martha B. Ruiz
    • 1
  • Judith M. Connett
    • 1
  • James W. Fleshman
    • 1
  1. 1.Department of Surgery—Section of Colorectal SurgeryWashington University School of MedicineSt. Louis

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