Targarona E M, Martínez J, Nadal A, Balagué C, Cardesa A, Pascual S, Trias M
Service of General and Digestive Surgery, University of Barcelona, Spain.
World J Surg. 1998 Jan;22(1):55-60; discussion 60-1. doi: 10.1007/s002689900349.
Port-site metastasis has been an unexpected finding after laparoscopic surgery in gastrointestinal cancer patients. No clear explanation exists for this phenomenom. The aims of this study were to evaluate the dissemination pattern in an experimental model of hepatocarcinoma in the rat and summarize current knowledge about the risks and the results of experimental studies on cancer dissemination during laparoscopic surgery. NDA-induced hepatocarcinoma was obtained in Sprague-Dawley rats. Tumors were manipulated during laparoscopy (group 1, n = 11) or laparotomy (group 2, n = 12). A Medline review of all experimental studies about the risk of cancer dissemination during laparoscopic surgery was undertaken. Both models were associated with implants in parietal wounds [1/11 in group 1 (9%) vs. 1/12 in group 2 (8%), p = NS]. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization, and cells can be recovered in trocars, filtered exhaust gas, and instruments. Postoperative immunosuppression, the biologic aggressiveness of the tumor, and the gas used for laparoscopy also influence tumoral growth. Port-site metastases are secondary to multiple factors, including the technical skill of the surgeon, the biologic properties of the tumors, and local environmental aspects. Undoubtedly, laparoscopy can help disseminate aggressive tumors and should be reserved for diagnostic and staging procedures or for treatment of low-grade malignant tumors. Therapeutic resection, especially of colon cancer, should be restricted to prospective and randomized trials until there are enough hard data to rule out the clinical importance of this potentially severe complication.
在胃肠道癌患者的腹腔镜手术后，术口转移一直是一个意外发现。对此现象尚无明确解释。本研究的目的是评估大鼠肝癌实验模型中的播散模式，并总结目前关于腹腔镜手术期间癌症播散风险及实验研究结果的知识。在Sprague-Dawley大鼠中诱发NDA诱导的肝癌。在腹腔镜检查期间（第1组，n = 11）或剖腹手术期间（第2组，n = 12）对肿瘤进行操作。对所有关于腹腔镜手术期间癌症播散风险的实验研究进行了Medline综述。两种模型均与腹壁伤口植入有关[第1组1/11（9%） vs. 第2组1/12（8%），p = 无显著性差异]。对当前文献的分析证实，腹腔镜检查与腹腔细胞动员有关，并且细胞可在套管针、过滤废气和器械中回收。术后免疫抑制、肿瘤的生物学侵袭性以及用于腹腔镜检查的气体也会影响肿瘤生长。术口转移是多种因素导致的，包括外科医生的技术水平、肿瘤的生物学特性以及局部环境因素。毫无疑问，腹腔镜检查可能有助于播散侵袭性肿瘤，应仅用于诊断和分期程序或用于治疗低级别恶性肿瘤。在有足够确凿数据排除这种潜在严重并发症的临床重要性之前，治疗性切除，尤其是结肠癌的治疗性切除，应仅限于前瞻性随机试验。
