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Abdominal Wall Recurrence—Etiology and Precautions

  • Hubert Scheuerlein
  • C. Schug
  • C. Schneider
  • Ferdinand Köckerling

Abstract

The explosive development of minimally invasive surgical procedures has revolutionized the treatment of benign diseases in all specialities in which surgery is practiced. While the minimally invasive modality can now be considered to be the treatment of choice for numerous indications, such as the surgical treatment of cholecystolithiasis or gastroesophageal reflux disease, its use in the treatment of malignant diseases remains controversial. Since long-term results are for the most part lacking, a definitive evaluation of the advantages of minimally invasive surgery and the problems associated with it is, at the present time, not possible. In recent years, the characteristics of minimally invasive surgical procedures have been subject to research efforts at a level of intensity not seen in any other field of clinical and experimental surgery. The advantages of the minimally invasive surgical modality—less immunologic trauma, more rapid postoperative recovery, less postoperative pain, etc.—have repeatedly been demonstrated. On the other hand, the question as to whether thoracoscopic and laparoscopic oncologic interventions have any effect on the long-term survival of patients treated in this way has not yet been finally clarified. With regard to laparoscopic oncologic interventions on the colorectum, however, the short-term results and early long-term results published so far do appear to suggest that these procedures are not associated with any disadvantages for the patient,1–4 although it has repeatedly been emphasized that compliance with strict criteria for the establishment of the indication is of paramount importance. With regard to oncologic considerations, laparoscopic interventions on the colorectum are presumably the most thoroughly investigated of such interventions. Thus, much of what we now know about port-site recurrences (PSRs) stems from this clinical and experimental field of research. PSRs must now be considered to be one of the most serious complications of minimally invasive oncologic surgical procedures. The mechanisms of development of PSRs and the possibilities of avoiding them are therefore the main focus of this chapter.

Keywords

Laparoscopic Intervention Trocar Site Port Site Metastasis Trocar Incision Peritoneal Wound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Franklin ME Jr, Rosenthal D, Abrego-Medina D, et al. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five year results. Dis Colon Rectum 1996; 39: S35–46.PubMedCrossRefGoogle Scholar
  2. 2.
    Milsom JW, Böhm B, Hammerhofer KA, et al. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998; 187: 46–54.PubMedCrossRefGoogle Scholar
  3. 3.
    Köckerling F, Reymond MA, Schneider C, et al. Prospective multicentre study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer. Dis Colon Rectum 1998; 41: 963–970.PubMedCrossRefGoogle Scholar
  4. 4.
    Poulin EC, MamazzaJ, Schlachta CM, et al. Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 1999; 229: 487–492.Google Scholar
  5. 5.
    Döbrönte Z, Wittmann T, Karâcsony G. Rapid development of malignant metastases in the abdominal wall after laparoscopy. Endoscopy 1978; 10: 127–130.PubMedCrossRefGoogle Scholar
  6. 6.
    Egan C, Knolmayer TJ, Bowyer MW, et al. Port site recurrences: a current review of the literature. Surg Endosc 1997; 11: 196 (abst).Google Scholar
  7. 7.
    Z’graggen K, Birrer S, Maurer CA, et al. Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery 1998; 124: 831–838.PubMedCrossRefGoogle Scholar
  8. 8.
    Schaeff B, Paolucci V, Thomopoulos J. Port site recurrences after laparoscopic surgery. Dig Surg 1998; 15: 124–134.PubMedCrossRefGoogle Scholar
  9. 9.
    Pearlstone DB, Mansfield PF, Curley SA, et al. Laparoscopy in 533 patients with abdominal malignancy. Surgery 1999; 125: 67–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Clinical outcomes of surgical therapy (COST) study group: Fleshman JW, Nelson H, Peters WR, et al. Early results of laparoscopic surgery for colorectal cancer. Dis Colon Rectum 1996; 39: S53–58.CrossRefGoogle Scholar
  11. 11.
    Hoffman GC, Baker JW, Doxey JB, et al. Minimally invasive surgery for colorectal cancer. Initial follow-up. Ann Surg 1996; 223: 790–798.PubMedCrossRefGoogle Scholar
  12. 12.
    Lord SA, Larach SW, Ferrara A, et al. Laparoscopic resections for colorectal carcinoma. A three-year experience. Dis Colon Rectum 1996; 39: 148–154.PubMedCrossRefGoogle Scholar
  13. 13.
    Lumley JW, Fielding GA, Rhodes M, et al. Laparoscopic-assisted colorectal surgery. Dis Colon Rectum 1996; 39: 155–159.PubMedCrossRefGoogle Scholar
  14. 14.
    Vukasin P, Ortega AE, Greene FL, et al. Wound recurrence following laparoscopic colon cancer resection. Dis Colon Rectum 1996; 39: 5 2023.Google Scholar
  15. 15.
    Ramos JR, Petrosemolo RH, Valory RH, et al. Abdominoperineal resection: laparoscopic versus conventional. Surg Laparosc Endosc 1997; 7: 148–152.PubMedCrossRefGoogle Scholar
  16. 16.
    Wu JS, Birnbaum EH, Fleshman JW. Early experience with laparoscopic abdominoperineal resection. Surg Endosc 1997; 11: 449–455.PubMedCrossRefGoogle Scholar
  17. 17.
    Lacy AM, Delgado S, Garcia-Valdecasas JC, et al. Port site metastases and recurrence after laparoscopic colectomy. Surg Endosc 1998; 12: 1039–1042.PubMedCrossRefGoogle Scholar
  18. 18.
    Trebuchet G, Le Calve J, Launois B. Laparoscopic resection of the colon for adenocarcinoma. Report of a series of 218 cases. Chirurgie 1998; 123: 343–350.PubMedCrossRefGoogle Scholar
  19. 19.
    Leung KL, Yiu RY, Lai PB, et al. Laparoscopicassisted resection of colorectal carcinoma: five-year audit. Dis Colon Rectum 1999; 42: 327–332.PubMedCrossRefGoogle Scholar
  20. 20.
    Santoro E, Carlini M, Carboni F, et al. Colorectal carcinoma: laparoscopic versus traditional open surgery. A clinical trial. Hepatogastroenterology 1999; 46: 900–904.PubMedGoogle Scholar
  21. 21.
    Kadar N. Port-site recurrences following laparoscopic operations for gynaecological malignancies. Br J Obstet Gynaecol 1997; 104: 1308 1313.Google Scholar
  22. 22.
    Childers JM, Aqua KA, Surwit EA, et al. Abdominal-wall tumor implantation after laparoscopy for malignant conditions. Obstet Gynecol 1994; 84: 765–769.PubMedGoogle Scholar
  23. 23.
    Boutin C, Rey F, Viallat JR. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. Chest 1995; 108: 754–758.PubMedCrossRefGoogle Scholar
  24. 24.
    Kruitwagen RF, Swinkels BM, Keyser KG, et al. Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer. Gynecol Oncol 1996; 60: 233–237.PubMedCrossRefGoogle Scholar
  25. 25.
    Berends FJ, Kazemier G, Bonjer HJ, et al. Subcutaneous metastases after laparoscopic colectomy. Lancet 1994; 344: 58.PubMedCrossRefGoogle Scholar
  26. 26.
    Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995; 82: 295–298.PubMedCrossRefGoogle Scholar
  27. 27.
    Hohenberger W, Altendorf-Hofmann A, Schmidt O. Surgical therapy for metastases of the soft tissue. Langenbecks Arch Chir 1995;suppl 2: 288–294.Google Scholar
  28. 28.
    Hughes ES, McDermott FT, Polglase AL, et al. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery. Dis Colon Rectum 1983; 26: 571–572.PubMedCrossRefGoogle Scholar
  29. 29.
    Reilly WT, Nelson H, Schroeder G, et al. Wound recurrence following conventional treatment of colorectal cancer. Dis Colon Rectum 1996; 39: 200–207.PubMedCrossRefGoogle Scholar
  30. 30.
    Gunderson LL, Sosin H. Areas of failure found at reoperation (second symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Cancer 1974; 34: 1278–1292.PubMedCrossRefGoogle Scholar
  31. 31.
    Yokoi K, Miyazawa N, Imura G. Isolated incisional recurrence after curative resection for primary lung cancer. Ann Thorac Surg 1996; 61: 1236–1237.PubMedCrossRefGoogle Scholar
  32. 32.
    Former JG, Lawrence W. Implantation of gastric cancer in abdominal wounds. Ann Surg 1960; 152: 789–794.CrossRefGoogle Scholar
  33. 33.
    Stage JG, Schulze S, Moller P, et al. Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg 1997; 84: 391–396.PubMedCrossRefGoogle Scholar
  34. 34.
    Neuhaus SJ, Texler M, Hewett PJ, et al. Port-site metastases following laparoscopic surgery. Br J Surg 1998; 85: 735–741.PubMedCrossRefGoogle Scholar
  35. 35.
    Pahlmann L. The problem of port-site metastases after laparoscopic cancer surgery. Ann Med 1997; 29: 477–481.CrossRefGoogle Scholar
  36. 36.
    Hubbard JC. Report of a case of accidental implantation of an epithelioma. Surg Gynecol Ob-stet 1909; 9: 358.Google Scholar
  37. 37.
    Deelman HT. The part played by injury and repair in the development of cancer. Br Med J 1927; 1: 872.PubMedCrossRefGoogle Scholar
  38. 38.
    Saphir O. Transfer of tumor cells by surgical knife. Surg Gynecol Obstet 1936; 63: 775–776.Google Scholar
  39. 39.
    Ackerman LV, Wheat M. The implantation of cancer-an avoidable surgical risk? Surgery 1955; 37: 341–355.PubMedGoogle Scholar
  40. 40.
    Thomas CG. Tumor cell contamination of the surgical wound: experimental and clinical observations. Ann Surg 1961; 153: 697–704.PubMedCrossRefGoogle Scholar
  41. 41.
    Dalfen R, Calhoun K, Gilas T, et al. Radio-frequency hyperthermia as adjuvant therapy following surgical resection of an experimental malignant neoplasm. Cancer 1985; 55: 2737 2740.Google Scholar
  42. 42.
    Murthy MS, Travis JD, Scanlon EF. Factors influencing the growth and metastatic behavior of tumors. J Surg Oncol 1987; 35: 44–49.PubMedCrossRefGoogle Scholar
  43. 43.
    Murthy MS, Goldschmidt RA, Rao LN, et al. The influence of surgical trauma on experimental metastasis. Cancer 1989; 64: 2035–2044.PubMedCrossRefGoogle Scholar
  44. 44.
    Murthy MS, Summaria LJ, Miller RJ, et al. Inhibition of tumor implantation at sites of trauma by plasminogen activators. Cancer 1991; 68: 1724–1730.PubMedCrossRefGoogle Scholar
  45. 45.
    Martinez J, Targarona EM, Balague C, et al. Port site metastasis. An unresolved problem in laparoscopic surgery. A review. Int Surg 1995; 80: 315–321.PubMedGoogle Scholar
  46. 46.
    Nduka CC, Monson JRT, Menzies-Gow N, et al. Abdominal wall metastases following laparoscopy. Br J Surg 1994; 81: 648–652.PubMedCrossRefGoogle Scholar
  47. 47.
    Majno G, Joris I. Cells, tissues and disease. New York: Blackwell Science, 1996: 766.Google Scholar
  48. 48.
    Johnstone PAS, Rohde DC, Swartz SE, et al. Port site recurrences after laparoscopic and thoracoscopic procedures in malignancy. J Clin On-col 1996; 14: 1950–1956.Google Scholar
  49. 49.
    Reymond MA, Schneider C, Kastl S, et al. The pathogenesis of port-site recurrences. J Gastrointest Surg 1998; 2: 406–414.PubMedCrossRefGoogle Scholar
  50. 50.
    Champault G, Taffinder N, Ziol M, et al. Cells are present in the smoke created during laparoscopic surgery. Br J Surg 1997; 84: 993–995.PubMedCrossRefGoogle Scholar
  51. 51.
    Texler ML, King G, Hewett P. A comparative study of the effect of heated-humidified CO2 on intraperitoneal tumour cell dispersal during laparoscopy. Aust NZ J Surg 1997;67(suppl 1):A28 (abst).Google Scholar
  52. 52.
    Knolmayer TJ, Egan JC, Bowyer MW, et al. Aerosolization of tumor cells during carbon dioxide insufflation. Surg Endosc 1997; 11: 204 (abst).Google Scholar
  53. 53.
    Subramanian S, Bowyer MW, Knolmayer TJ, et al. Differential aerosolization of tumor cells during carbon dioxide insufflation. Surg Endosc 1998; 12: 518.Google Scholar
  54. 54.
    Reymond MA, Wittekind C, Jung A, et al. The incidence of port-site metastases might be reduced. Surg Endosc 1997; 11: 902–906.PubMedCrossRefGoogle Scholar
  55. 55.
    Bonjer J, van Dam JH, Romjin M, et al. Port site metastases: role of aerosolization of tumor cells. Surg Endosc 1997; 11: 192 (abst).Google Scholar
  56. 56.
    Allardyce R, Morreau P, Bagshaw P. Tumor cell distribution following laparoscopic colectomy in a porcine model. Dis Colon Rectum 1996; 39: S47–52.PubMedCrossRefGoogle Scholar
  57. 57.
    Hewett PJ, Thomas WM, King G, et al. Intra-abdominal cell movement during abdominal carbon dioxide insufflation and laparoscopy. Dis Colon Rectum 1996; 39: S62–66.PubMedCrossRefGoogle Scholar
  58. 58.
    Whelan RL, Sellers GJ, Allendorf JG, et al. Trocar site recurrence is unlikely to result from aerosolization of tumor cells. Dis Colon Rectum 1996; 39: S7–13.PubMedCrossRefGoogle Scholar
  59. 59.
    Buchmann P, Christen D, Moll C, et al. Intra-peritoneal tumor cell spread during colorectal cancer surgery: a comparison of laparoscopic versus open surgery. Langenbecks Arch Chir 1996; 381 (suppl 2): 573–576.Google Scholar
  60. 60.
    Doudle M, King G, Thomas WM, et al. The movement of mucosal cells of the gallbladder within the peritoneal cavity during laparoscopic cholecystectomy. Surg Endosc 1996; 10: 1092–1094.PubMedCrossRefGoogle Scholar
  61. 61.
    Cavina E, Goletti O, Molea N, et al. Trocar site tumor recurrences. Surg Endosc 1998; 12: 1294 1296.Google Scholar
  62. 62.
    Bouvy ND, Marquet RL, Lambert SWJ, et al. Laparoscopic bowel resection in the rat: earlier restoration of IGF-1 and less tumor growth. Surg Endosc 1996; 10: 567 (abst).Google Scholar
  63. 63.
    Dorrance HR, Oein K, O’Dwyer PJ. Laparoscopy promotes tumour growth in an animal model. Surg Endosc 1996; 10: 559 (abst).Google Scholar
  64. 64.
    Hubens G, Pauwels M, Hubens A, et al. The influence of a pneumoperitoneum on the peritoneal implantation of free intraperitoneal colon cancer cells. Surg Endosc 1996; 10: 809–812.PubMedCrossRefGoogle Scholar
  65. 65.
    Jacobi CA, Sabat R, Böhm B, et al. Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells. Surgery 1997; 121: 72–78.PubMedCrossRefGoogle Scholar
  66. 66.
    Jones DB, Guo LW, Reinhard MK, et al. Impact of pneumoperitoneum on trocar site implantation of cancer in a hamster model. Dis Colon Rectum 1995; 38: 1182–1188.PubMedCrossRefGoogle Scholar
  67. 67.
    Mathew G, Watson DI, Rofe AM, et al. Wound metastases following laparoscopic and open surgery for abdominal cancer in a rat model. Br J Surg 1996; 83: 1087–1090.PubMedCrossRefGoogle Scholar
  68. 68.
    Watson DI, Mathew G, Ellis T, et al. Gasless laparoscopy may reduce the risk of port-site metastases following laparoscopic tumor surgery. Arch Surg 1997; 132: 166–168.PubMedCrossRefGoogle Scholar
  69. 69.
    Bouvy ND, Marquet RL, Jeekel H, et al. Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases. Ann Surg 1996; 224: 694–700.PubMedCrossRefGoogle Scholar
  70. 70.
    Neuhaus SJ, Watson DI, Ellis T, et al. Wound metastasis after laparoscopy with different insufflation gases. Surgery 1998; 123: 579–583.PubMedCrossRefGoogle Scholar
  71. 71.
    Neuberger TJ, Andrus CH, Wittgen CM, et al. Prospective comparison of helium versus carbon dioxide pneumoperitoneum. Gastrointest Endosc 1996; 43: 38–41.PubMedCrossRefGoogle Scholar
  72. 72.
    Bongard FS, Pianim N, Liu SY, et al. Using helium for insufflation during laparoscopy [letter]. JAMA 1991; 266: 3131.PubMedCrossRefGoogle Scholar
  73. 73.
    Southern DA, Mapleson WW. Which insufflation gas for laparoscopy? [letter]. BMJ 1993; 307: 1424.PubMedCrossRefGoogle Scholar
  74. 74.
    Voltz J, Koster S, Weiss M, et al. Pathophysiologic features of a pneumoperitoneum at laparoscopy: a swine model. Am J Obstet Gynecol 1996; 174: 132–140.CrossRefGoogle Scholar
  75. 75.
    Voltz J, Koster S, Melchert F. The effects of pneumoperitoneum of intraabdominal tumour implantation in nude mice. Gynaecol Endosc 1996; 5: 193–196.CrossRefGoogle Scholar
  76. 76.
    Watson RW, Redmond HP, McCarthy J, et al. Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model. Br J Surg 1995; 82: 1060–1065.PubMedCrossRefGoogle Scholar
  77. 77.
    West MA, Baker J, Bellingham J. Kinetics of decreased LPS-stimulated cytokine release by macrophages exposed to CO2. J Surg Res 1996; 63: 269–274.PubMedCrossRefGoogle Scholar
  78. 78.
    Southall JC, Lee SW, Bessler M, et al. The effect of peritoneal air exposure on postoperative tumor growth. Surg Endosc 1998; 12: 348–350.PubMedCrossRefGoogle Scholar
  79. 79.
    Buhr J, Hürtgen M, Kelm C, et al. Tumor dissemination after thoracoscopic resection for lung cancer. J Thorac Cardiovasc Surg 93. 1995; 110: 855–856.Google Scholar
  80. 80.
    Fry WA, Sidiqqui A, Pensler JM. Thoracoscopic implantation of cancer with a fatal outcome. Ann Thorac Surg 1995; 59: 42–45.PubMedCrossRefGoogle Scholar
  81. 81.
    Downey RJ, McCormack P, LoCicero III J, and the Video-Assisted Thoracic Surgery Study Group. Dissemination of malignancies following video-assisted thoracic surgery. J Cardiovasc Thorac Surg 1996; 111: 954–960.CrossRefGoogle Scholar
  82. 8.2.
    Allendorf JD, Bessler M, Kayton ML, et al. Increased tumor establishment and growth after laparotomy vs laparoscopy in a murine model. Arch Surg 1995; 130: 649–653.PubMedCrossRefGoogle Scholar
  83. 83.
    Bouvy ND, Marquet RL, HammingJF, et al. Laparoscopic surgery in the rat. Beneficial effect on body weight and tumor take. Surg Endosc 1996; 10: 490–494.PubMedCrossRefGoogle Scholar
  84. 84.
    Jacobi CA, Ordermann J, Böhm B, et al. Increased tumor growth after laparotomy and laparoscopy with air versus CO2. Surg Endosc 1996; 10: 55 (abst).Google Scholar
  85. 85.
    Mathew G, Watson DI, Rofe AM, et al. Adverse impact of pneumoperitoneum on intraperitoneal implantation and growth of tumor cell suspension in an experimental model. Aust NZ J Surg 1997; 67: 289–292.CrossRefGoogle Scholar
  86. 86.
    Le Moine MC, Navarro F, Burge’ JS, et al. Ex- 100. perimental assessment of the risk of tumor recurrence after laparoscopic surgery. Surgery 1998; 123: 427–431.PubMedCrossRefGoogle Scholar
  87. 87.
    Griffith JP, Everitt NJ, Lancaster F, et al. Influence of laparoscopic and conventional cholecystectomy upon cell-mediated immunity. Br J Surg 1995; 82: 677–680.PubMedCrossRefGoogle Scholar
  88. 88.
    Lennard TW, Shenton BK, Borzotta A, et al. The influence of surgical operations on components of the human immune system. Br J Surg 1985; 72: 771–776.PubMedCrossRefGoogle Scholar
  89. 89.
    Little D, Regan M, Keane RM, et al. Perioperative immune modulation. Surgery 1993; 114: 87–91.PubMedGoogle Scholar
  90. 90.
    Trokel MJ, Bessler M, Treat MR, et al. Preservation of immune response after laparoscopy. Surg Endosc 1994; 8: 1385–1387.PubMedCrossRefGoogle Scholar
  91. 91.
    Allendorf JD, Bessler M, Whelan RL, et al. Better preservation of immune function after laparoscopic-assisted vs. open bowel resection in a murine model. Dis Colon Rectum 1996; 39 (suppl 10): S67–72.PubMedCrossRefGoogle Scholar
  92. 92.
    Collet D, Vitale GC, Reynolds M, et al. Peritoneal host defenses are less impaired by laparoscopy than by open operation. Surg Endosc 1995; 9: 1059–1064.PubMedCrossRefGoogle Scholar
  93. 93.
    Bouvy ND, Marquet RL, Hamming JF, et al. Laparoscopie surgery in the rat. Beneficial effect on body weight and tumor take. Surg Endosc 1996; 10: 490–494.PubMedCrossRefGoogle Scholar
  94. 94.
    Skipper D, Jeffrey M, Cooper AJ, et al. Enhanced growth of tumour cells in healing colonic anastomosis and laparotomy wounds. Int J Colorect Dis 1989; 4: 172–177.CrossRefGoogle Scholar
  95. 95.
    Goldstein DS, Lu ML, Hattori T, et al. Inhibition of peritoneal tumor-cell implantation: model for laparoscopie cancer surgery. J Endourol 1993; 7: 237–241.PubMedCrossRefGoogle Scholar
  96. 96.
    Jones LM, Gardner MJ, Catterall JB, et al. Hyaluronic acid secreted by mesothelial cells: a natural barrier to ovarian cancer cell adhesion. Clin Exp Metastasis 1995; 13: 373–380.PubMedCrossRefGoogle Scholar
  97. 97.
    Jacobi CA, Ordemann J, Böhm B, et al. Inhibition of peritoneal tumor cell growth and implantation in laparoscopie surgery in a rat model. Am J Surg 1997; 174: 359–363.PubMedCrossRefGoogle Scholar
  98. 98.
    Neuhaus SJ, Watson DI, Ellis T, et al. Efficacy of cytotoxic agents for the prevention of laparoscopic port-site metastases. Arch Surg 1998; 133: 762–766.PubMedCrossRefGoogle Scholar
  99. 99.
    Tseng LNL, Berends FJ, Wittich P, et al. Port-site metastases-impact of local tissue trauma and gas leakage. Surg Endosc 1998; 12: 1377 1380.Google Scholar
  100. 100.
    Bonjer HJ, Tseng L, Kazemier G, et al. Portsite metastases: role of local ischemia. Surg Endosc 1997; 11: 175 (abst).Google Scholar
  101. 101.
    Wu JS, Guo LW, Ruiz MB, et al. Excision of trocar sites reduces implantation in an animal model. Dis Colon Rectum 1998; 41: 1107–1111.PubMedCrossRefGoogle Scholar
  102. 102.
    Lee SW, Southall J, Allendorf J, et al. Traumatic handling of the tumor independent of pneumoperitoneum increases port site implantation rate of colon cancer in a murine model. Surg Endosc 1998; 12: 828–834.PubMedCrossRefGoogle Scholar
  103. 103.
    Zirngibl H, Husemann B, Hermanek P. Intra-operative spillage of tumor cells in surgery for rectal cancer. Dis Colon Rectum 1990; 33: 610614.Google Scholar
  104. 104.
    Allardyce RA, Morreau P, Bagshaw PE Operative factors affecting tumor cell distribution following laparoscopic colectomy in a porcine model. Dis Colon Rectum 1997; 40: 939–945.PubMedCrossRefGoogle Scholar
  105. 105.
    Hohenberger W, Schneider C, Reymond MA, et al. May we perform laparoscopic colorectal resections for cure? Zentralbi Chir 1997; 122: 1127–1133.Google Scholar
  106. 106.
    Hermanek P, Wittekind C. To what extent are laparoscopic procedures defensible in oncologic surgery? Chirurg 1994; 65: 23–28.PubMedGoogle Scholar
  107. 107.
    Wagner G, Hermanek P. Organspezifische Tumordokumentation. Berlin: Springer, 1994.Google Scholar
  108. 108.
    Hermanek P, Giedl J, Altendorf A. Häufigkeit, Typ und Klassifikation der lymphogenen Metastasierung gastrointestinaler Karzinome. Verh Dtsch Ges Pathol 1984; 68: 284.Google Scholar
  109. 109.
    Lewin KJ, Riddell RH, Weinstein WM. Gastrointestinal Pathology and Its Clinical Implications. New York: Igaku-Shoin, 1992.Google Scholar
  110. 110.
    Köckerling F, Reymond MA, Schneider C, et al. Mistakes and hazards in oncological laparoscopic surgery. Chirurg 1997; 68: 215–224.PubMedGoogle Scholar
  111. 111.
    Eshraghi N, Bax T, Jobe BA, et al. The effect of laparoscopic port site irrigation on the incidence of wound site metastases. Surg Endosc 1998; 12: 512 (abst).Google Scholar
  112. 112.
    Schneider C, Schug C, Köckerling F. Illustrated practical notes for the surgeon. In: Reymond MA, Bonjer HJ, Köckerling F (Eds.): Port-site and wound recurrences in cancer surgery, Berlin: Springer, 2000, pp. 124–128.CrossRefGoogle Scholar
  113. 113.
    Köckerling F, Schneider C, Reymond MA, et al. Suturing of the port site following laparoscopy. Zentralbl Chir 1997; 122: 833–836.PubMedGoogle Scholar
  114. 114.
    Lee SW, Bessler M, Whelan RL. Peritoneal irrigation with betadine solution following laparoscopic splenectomy significantly decreases port tumor recurrence in a murine model. Surg Endosc 1998; 12: 514 (abst).Google Scholar
  115. 115.
    Sugarbaker PH, Cunliffe WJ, Belliveau J, et al. Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Sem On-col 1989; 16 (suppl 6): 83–97.Google Scholar
  116. 116.
    Jacquet P, Sugarbaker PH. Wound recurrence after laparoscopic colectomy for cancer—new rationale for intraoperative intraperitoneal chemotherapy. Surg Endosc 1996; 10: 295–296.PubMedCrossRefGoogle Scholar
  117. 117.
    Reymond MA, Hu B, Garcia A, et al. Feasibility of therapeutic pneumoperitoneum in a large animal model using a microvaporisator. Surg Endosc 2000; 14: 51–55.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Hubert Scheuerlein
  • C. Schug
  • C. Schneider
  • Ferdinand Köckerling

There are no affiliations available

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