Påhlman L
Ann Med. 1997 Dec;29(6):477-81. doi: 10.3109/07853899709007471.
The whole era of laparoscopic surgery for cancer began with the same optimistic view as for benign disease. However, port-site metastases were published as soon as in 1993. According to literature, it is difficult to estimate exactly the incidence of port-site metastases in laparoscopic colon cancer surgery. Moreover, there are few reports of wound recurrences after open surgery although the incidence is probably about 1%. There are some hypothetical explanations of metastases to the laparoscopic wound, which have not been solved. It can be a haematogenic spread to the wound. Another mechanism could be an aerosol of tumour cells and a third one adhesions of tumour cells to the surface of the instruments or ports. This editorial discusses some of the possible mechanisms of port-site recurrences. Also, most importantly, the justification for laparoscopic surgery for colon cancer is discussed. Only through randomized trials can this question be solved. Therefore, it is mandatory to include patients in a trial and colorectal cancer patients should not undergo laparoscopic surgery outside a clinical randomized trial.
癌症腹腔镜手术的整个时代始于与良性疾病相同的乐观观点。然而，早在1993年就有关于穿刺孔转移的报道。根据文献，很难准确估计腹腔镜结肠癌手术中穿刺孔转移的发生率。此外，尽管开放手术后伤口复发的发生率可能约为1%，但相关报道较少。对于腹腔镜伤口转移存在一些假设性解释，但尚未得到解决。可能是血行播散至伤口。另一种机制可能是肿瘤细胞气溶胶，第三种机制是肿瘤细胞粘附于器械或穿刺孔表面。这篇社论讨论了穿刺孔复发的一些可能机制。同样，最重要的是，讨论了结肠癌腹腔镜手术的合理性。只有通过随机试验才能解决这个问题。因此，必须将患者纳入试验，结直肠癌患者不应在临床随机试验之外接受腹腔镜手术。
