Port-site metastases after CO(2) laparoscopy. Is aerosolization of tumor cells a pivotal factor?

Abstract

Background: Animal experiments have shown that carbon dioxide (CO(2)) laparoscopy results in more port-site recurrences than gasless laparoscopy. Possible transport of aerosolized tumor cells by CO(2) was investigated in rats.

Methods: Abdominal cavities of 15 pairs of Wistar Agouti (WAG) rats were connected and 2 x 10(6) or 16 x 10(6) CC 531 cells were injected in the first (donor) rat of each pair. Then 10 l of CO(2) were allowed to flow from the first (donor) to the second (recipient) rat.

Results: No tumor was found in the recipients after injection of 2 x 10(6) cells in the donors. Injection of 16 x 10(6) cells in the donors resulted in very limited tumor growth in the recipients.

Conclusions: Aerosolization of tumor cells occurs, but the number of intraperitoneal tumor cells required for metastases to occur by this mechanism is extremely high. Therefore, aerosolization of tumor cells appears not to be of major relevance in the pathogenesis of port-site metastases.