Laparoscopic surgery for malignancy has been complicated by port-site recurrences. The exact mechanism has yet to be defined. In vitro studies suggest that carbon dioxide-induced tumor cell aerosolization may play a role. We have attempted to document this in a human model. Patients scheduled for elective laparoscopy underwent port placement and abdominal insufflation with carbon dioxide. A suction trap was then filled with 40 cc of normal saline solution and attached to an insufflation site on the port. The carbon dioxide effluent was directed through the saline. The specimen was concentrated, resuspended, and transferred to a slide. A Papanicolaou stain was used. Thirty-five specimens were obtained. Fifteen patients (37%) had malignant disease, which was metastatic in eight. Five patients had carcinomatosis. In two of those with carcinomatosis, staining revealed a large number of malignant cells. Malignant cells were not found in any other patients. In two patients, however, aerosolized mesothelial cells were identified. Follow-up ranged from 2 to 7 months. One patient who displayed cellular aerosolization developed a port-site recurrence. We conclude that malignant cells are aerosolized but only during laparoscopy in the presence of carcinomatosis. It is unlikely that tumor cell aerosolization contributes significantly to port-site metastasis.
Bibliographical noteFunding Information:
Potential subjects were identified by the attending physician either during outpatient workup or at the time of inpatient consultation. Informed consent was obtained. No patients were immunodeficient. Patients undergoing radiation chemotherapy or those with acute inflammatory disorders were excluded. Prior approval was obtained from the institutional review board before the study was conducted. All patients were scheduled for elective laparoscopy. General anesthesia was used in all cases. Prophylaxis against venous stasis and deep venous thrombosis was achieved using pneumatic compression devices. Patients were From the Department of Surgery, Division of General Surgery, and the Department of Surgical Pathology (J.L.), Ohio State University Medical Center, Columbus, Ohio. Supported in part by a grant from United States Surgical Corporation. Presented at the Thirty-Eighth Annual Meeting of The Societyf or Surgery of the Alimentary Tract, Washington, D.C., May 11-14, 1997. Reprint requests: W. Scott Melvin, M.D., Department of Surgery, Ohio State UniversityM edical Center, N729 Doan Hall, 410 West 10th Ave., Columbus, OH 43210.
- Carbon dioxide
- Tumor cell