Abstract
Background
The mechanism of port-site metastasis after laparoscopic cancer surgery is unclear. This study aimed to determine whether carbon dioxide (CO2) pneumoperitoneum caused an increase in hyaluronic acid, which is secreted from mesothelial cells of the peritoneal cavity, and to assess the risk for port-site metastasis using a murine pneumoperitoneal model.
Methods
Sandwich-binding protein assay was used to measure the concentration of hyaluronic acid in the peritoneal cavity at 6, 12, 18, 24, 48, and 72 h after CO2 pneumoperitoneum or laparotomy for 30 min. The concentrations of hyaluronic acid during pneumoperitoneum were compared among different gases (CO2, helium, air), intervals (5, 30, 60 min), and pressures (0–2, 4–6, 8–10 mmHg). To investigate the effects of exogenous hyaluronic acid, the development of port-site metastasis was examined using mouse adenocarcinoma cell-line colon 26 cells.
Results
The intraperitoneal concentration of hyaluronic acid after CO2 pneumoperitoneum had increased already at 6 h, had reached the maximum level at 24 h, and had begun to decrease at 72 h. The concentration of hyaluronic acid at 24 h and 48 h in the CO2 pneumoperitoneum group was higher than that in the laparotomy group. This increase in hyaluronic acid also was found during helium and air pneumoperitoneum, and the concentration of hyaluronic acid in the peritoneal cavity was at its maximum when CO2 pneumoperitoneum lasted 30 min at 4 to 6 mmHg. The frequency of port-site metastasis was the highest when hyaluronic acid was injected during CO2 pneumoperitoneum (100%).
Conclusions
In a murine model, the intraperitoneal concentration of hyaluronic acid was significantly increased after CO2 pneumoperitoneum, and the increase was more evident than that after laparotomy. Increased hyaluronic acid during pneumoperitoneum may be associated with port-site metastasis after laparoscopic cancer surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allardyce RA, Morreau P, Bagshaw PF (1997) Operative factors affecting tumor cell distribution following laparoscopic colectomy in a porcine model. Dis Colon Rectum 40: 939–945
Allendorf JDF, Bessler M, Kayton ML, Oesterling SD, Treat MR, Nowygrod R, Whelan RL (1995) Increased tumor establishment and growth after laparotomy vs laparoscopy in a murine model. Arch Surg 130: 649–653
Aoki Y, Shimura H, Li H, Mizumoto K, Date K, Tanaka M (1999) A model of port-site metastases of gallbladder cancer: the influence of peritoneal injury and its repair on abdominal wall metastases. Surgery 125: 553–559
Bouvy ND, Marquet RL, Jeekel H, Bonjer HJ (1996) Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases. Ann Surg 224: 694–701
Breborowicz A., Rodela H, Karon J, Martis L, Oreopoulos DG (1997) In vitro simulation of the effect of peritoneal dialysis solution on mesothelial cells. Am J Kidney Dis 29: 404–409
Hewett PJ, Thomas WM, King G, Eaton M (1996) Intraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy: an in vivo model. Dis Colon Rectum 39: S62-S66
Hillerdal G, Lindqvist U, Engström-Laurent A (1991) Hyaluronan in pleural effusions and in serum. Cancer 67: 2410–2414
Khalili TM, Fleshner PR, Hiatt JR, Sokol TP, Manookian C, Tsushima G, Phillips EH (1998) Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 41: 832–838
Kitano S, Shimoda K, Miyahara M, Shiraishi N, Bandoh T, Yoshida T, Shuto K, Kobayashi M (1995) Laparoscopic approaches in the management of patients with early gastric carcinomas. Surg Laparosc Endosc 5: 359–362
Knolmayer TJ, Asbun HJ, Shibata G, Bowyer MW (1997) An experimental model of cellular aerosolization during laparoscopic surgery. Surg Laparosc Endosc 7: 399–402
Leung KL, Yiu RYC, Lai PBS, Lee JFY, Thung KH, Lau WY (1999) Laparoscopic-assisted resection of colorectal carcinoma: five-year audit. Dis Colon Rectum 42: 327–333
Martínez-Serna T, Stalter KD, Filipi CJ, Tomonaga T (1998) An unusual case of endometrial trocar site implantation. Surg Endosc 12: 992–994
Milsom JW, Böhm B, Hammerhofer KA, Fazio V, Steiger E, Elson P (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187: 46–57
Mutter D, Hairi A, Tassetti V, Solis-Caxaj C, Aprahamian M, Marescauz J (1999) Increased tumor growth and spread after laparoscopy vs laparotomy: influence of tumor manipulation in a rat model. Surg Endosc 13: 365–370 DOI: 10.1007/s004649900991
Oksala O, Salo T, Tammi R, Häkkinen H, Jalkanen M, Inki P, Larjava H (1995) Expression of proteoglycans and hyaluronan during wound healing. J Histochem Cytochem 43: 125–135
Poulin EC, Mamazza J, Schlachta CM, Grégoire R, Roy N (1999) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 229: 487–492
Suematsu T, Shiromizu A, Yamaguchi K, Shiraishi N, Adachi Y, Kitano S (1999) Convenient murine pneumoperitoneal model for the study of laparoscopic cancer surgery. Surg Laparosc Endosc 9: 279–281
West DC, Hampson IN, Arnold F, Kumar S (1985) Angiogenesis induced by degradation products of hyaluronic acid. Science 228: 1324–1326
Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy [review]. Br J Surg 82: 295–298
Volz J, Köster S, Spacek Z, Paweletz N (1999) Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum. Surg Endosc 13: 611–614 DOI: 10.1007/s004649901052
Author information
Authors and Affiliations
Additional information
Online publication: 18 October 2000
Rights and permissions
About this article
Cite this article
Yamaguchi, K., Hirabayashi, Y., Suematsu, T. et al. Hyaluronic acid secretion during carbon dioxide pneumoperitoneum and its association with port-site metastasis in a murine model. Surg Endosc 15, 59–62 (2001). https://doi.org/10.1007/s004640000238
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004640000238