Abstract
Background: Despite several clinical and experimental studies, the mechanisms behind the development of port site metastases in laparoscopic surgery have remained largely unknown. The current study was designed to investigate the effect of pneumoperitoneum on blood flow in the abdominal wall and its possible effects on tumor growth at this site.Methods: A total of 40 Wistar Fu rats had a laser Doppler probe placed on their left rectus muscle and a suspension of 50,000 adenocarcinoma cells was injected into their right rectus muscle. The experimental group (n = 20) was insufflated with air at 10 mmHg for 45 min while abdominal blood flow was registered before and during insufflation and after exsufflation. The control group (n = 20) was not insufflated but the blood flow was recorded in the same manner. After 9 days, all animals were killed and the occurrence of tumor was observed. The tumors were analyzed with respect to weight and volume. Results: The insufflation caused an 82% reduction in blood flow in the experimental group (p < 0.001). No reduction in blood flow was registered in the control group. Tumor nodules developed significantly more often in the insufflated group (20/20) compared to the controls (14/20) (p = 0.016). Tumor weight (p = 0.003) and volume (p < 0.001) were significantly increased in the insufflated group. Conclusions: Pneumoperitoneum seems to enhance tumor growth. It also causes a significant reduction in blood flow in the abdominal wall, which may contribute to the increased susceptibility of tumor take.
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References
R Berguer T Cornelius M Dalton (1997) ArticleTitleThe optimum pneumoperitoneum pressure for laparoscopic surgery in the rat model. A detailed cardiorespiratory study. Surg Endosc 11 915–918 Occurrence Handle10.1007/s004649900486 Occurrence Handle1:STN:280:ByiH3sbptFM%3D Occurrence Handle9294272
SM Brundell C Tsopelas B Chatterton J Touloumtzoglou (2002) ArticleTitleExperimental study of peritoneal blood flow and insufflation pressure during laparoscopy. Br J Surg 89 617–622 Occurrence Handle10.1046/j.1365-2168.2002.02071.x Occurrence Handle1:STN:280:DC%2BD383nsFantg%3D%3D Occurrence Handle11972553
M Canis Wattiez Botchorishvili, JL Pouly G Mage H Manhes MA Bruhat (2000) ArticleTitleCancer and laparoscopy, experimental studies: a review. Eur J Obstet Gynecol Reprod Biol 91 1–9 Occurrence Handle1:STN:280:DC%2BD3czos1Kmsg%3D%3D
G Carlsson B Gullberg L Hafström (1983) ArticleTitleEstimation of liver tumor volume using different formulas: an experimental study in rats. J Cancer Res Clin Oncol 105 20–23
A Clark J Youd S Rattigan E Barret M Clark (2001) ArticleTitleHeterogeneity of laser Doppler flowmetry in perfused muscle indicative of nutritive and non-nutritive flow. Am J Physiol Heart Circ Physiol 280 1324–1333
L Diebel J Saxe S Dulchavsky (1992) ArticleTitleEffect of intraabdominal pressure on abdominal wall blood flow. Am Surg 58 573–575 Occurrence Handle1:STN:280:By2A1MfhvFE%3D Occurrence Handle1388005
HS Ho CJ Saunders RA Gunther BM Wolfe (1995) ArticleTitleEffector of hemodynamics during laparoscopy: CO2 absorption or intra-abdominal pressure. J Surg Res 59 497–503 Occurrence Handle10.1006/jsre.1995.1198 Occurrence Handle1:STN:280:BymD3MzntF0%3D Occurrence Handle7564324
CA Jacobi R Sabat B Böhm HU Zieren HD Volk JM Muller (1997) ArticleTitlePneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells. Surgery 121 72 Occurrence Handle1:STN:280:ByiC2MvosVQ%3D Occurrence Handle9001554
K Krogh-Sorensen PD Line T Haaland RS Horn K Kvernebo (1992) ArticleTitleIntraoperative prediction of ischemic injury of the bowel: a comparision of laser Doppler flowmetry and tissue oximetry to histological analysis. Eur J Vasc Surg 6 518–524 Occurrence Handle1397347
K Kvernebo LE Staxrud EG Salerud (1990) ArticleTitleAssessment of human blood perfusion with single-fiber laser Doppler flowmetry. Microvasc Res 39 376–385 Occurrence Handle1:STN:280:By%2BA3c%2FpslI%3D Occurrence Handle2362559
O Lundberg A Kristofferson (1998) ArticleTitleEffect of pneumoperitoneum induced by carbon dioxide and air on tumor load in a rat model. World J Surg 22 470–472 Occurrence Handle10.1007/s002689900418 Occurrence Handle1:STN:280:DyaK1c3isFCmsw%3D%3D Occurrence Handle9564290
O Lundberg A Kristoffersson (1999) ArticleTitlePort site metastases from gallbladder cancer after laparoscopic cholecystectomy. Results from a Swedish survey and review of published reports. Eur J Surg 165 215–222 Occurrence Handle10.1080/110241599750007072 Occurrence Handle1:STN:280:DyaK1M3kvVCgtA%3D%3D Occurrence Handle10231654
O Lundberg A Kristoffersson (2000) ArticleTitleWound recurrence from gallbladder cancer after open cholecystectomy. Surgery 127 296–300 Occurrence Handle10.1067/msy.2000.104487 Occurrence Handle1:STN:280:DC%2BD3c7otV2gtg%3D%3D Occurrence Handle10715985
SM Murthy RA Goldsmith LN Rao M Ammirati T Buchmann EF Scanlon (1989) ArticleTitleThe influence of surgical trauma on experimental metastasis. Cancer 64 2035 Occurrence Handle1:STN:280:By%2BD3s%2FgvFY%3D Occurrence Handle2804892
J Neudecker S Sauerland E Neugebauer R Bergamaschi HJ Bonjer A Cuschieri K-H Fuchs CH Jacobi FW Jansen A-M Koivusalo A Lacy MJ McMahon B Millat W Schwenk (2002) ArticleTitleThe European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16 1121–1143 Occurrence Handle10.1007/s00464-001-9166-7 Occurrence Handle1:STN:280:DC%2BD38vhtFGhsQ%3D%3D Occurrence Handle12015619
KP Robinson E Hoppe (1962) ArticleTitleThe development of blood-borne metastases. Arch Surg 85 40–44
M Schilling C Redaelli L Krähenbühl C Signer M Büchler (1997) ArticleTitleSplanchnic microcirculatory changes during CO2 laparoscopy. J Am Col Surg 184 378–382 Occurrence Handle1:STN:280:ByiB2MrjtlI%3D
D Skipper MJ Jeffrey AJ Cooper P Alexander I Taylor (1989) ArticleTitleEnhanced growth of tumour cells in healing colonic anastomoses and laparotomy wounds. Int J Colorectal Dis 4 172 Occurrence Handle1:STN:280:BiaA28%2FptFM%3D Occurrence Handle2769000
GJ Smits RJ Roman JH Lombard (1986) ArticleTitleEvaluation of laser-Doppler flowmetry as a measure of tissue blood flow. J Appl Physiol 61 666–672 Occurrence Handle1:STN:280:BimA3cvgsFE%3D
RL Whelan SW Lee (1999) ArticleTitleReview of investigations regarding the etiology of port site tumor recurrence. J Laparoendosc Adv Surg Tech A 9 1–16 Occurrence Handle1:STN:280:DyaK1M3htVGqsw%3D%3D Occurrence Handle10194687
J Volz S Koster Z Spacek N Paweletz (1999) ArticleTitleThe influence of pneumoperitoneum used in laparoscopic surgery on an intraabdominal tumor growth. Cancer 86 770–774 Occurrence Handle10.1002/(SICI)1097-0142(19990901)86:5<770::AID-CNCR11>3.0.CO;2-3 Occurrence Handle1:STN:280:DyaK1MzptlChtw%3D%3D Occurrence Handle10463974
O Zmora EG Weiss (2001) ArticleTitleTrocar site recurrence in laparoscopic surgery for colorectal cancer. Myth or real concern. Surg Oncol Clin N Am 10 625–638 Occurrence Handle1:STN:280:DC%2BD3MnhtFWrsQ%3D%3D Occurrence Handle11685932
PA Öberg (1990) ArticleTitleLaser-Doppler flowmentry. Crit Rev Biomed Eng 18 25–63
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Financial support for this study was provided by Lions Cancer Research Foundation, University Hospital of Northern Sweden, Umeå, Sweden.
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Lundberg, O., Kristoffersson, A. Pneumoperitoneum impairs blood flow and augments tumor growth in the abdominal wall. Surg Endosc 18, 293–296 (2004). https://doi.org/10.1007/s00464-003-9035-7
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DOI: https://doi.org/10.1007/s00464-003-9035-7