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Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions

BACKGROUND: The use of advanced laparoscopy remains controversial in the field of surgical oncology because the potential for port-site recurrence may violate sound oncologic principles. Two mechanisms are theorized to be the cause of port-site recurrences: first, indirect contamination caused by pn...

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Autores principales: Wilkinson, Neal W., Shapiro, Andrew J., Harvey, Stephen B., Stack, Richard S., Cornum, Rhonda L.
Formato: Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 2001
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015444/
https://www.ncbi.nlm.nih.gov/pubmed/11548826
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author Wilkinson, Neal W.
Shapiro, Andrew J.
Harvey, Stephen B.
Stack, Richard S.
Cornum, Rhonda L.
author_facet Wilkinson, Neal W.
Shapiro, Andrew J.
Harvey, Stephen B.
Stack, Richard S.
Cornum, Rhonda L.
author_sort Wilkinson, Neal W.
collection PubMed
description BACKGROUND: The use of advanced laparoscopy remains controversial in the field of surgical oncology because the potential for port-site recurrence may violate sound oncologic principles. Two mechanisms are theorized to be the cause of port-site recurrences: first, indirect contamination caused by pneumoperitoneum, aerosolization, or intraperitoneal spread, and second, direct contamination by physical trocar seeding. METHODS: A VX-2 carcinoma cell suspension was transferred under the left renal capsule of 31 rabbits with either an open flank incision (16) or laparoscopy (15). Animals were observed for tumor recurrence at the video port, the working port, and the open incision. Intraoperative findings and necropsy were used to document recurrence. RESULTS: The open incision technique resulted in local tumor recurrence in 1/16 animals with 16/16 viable intraabdominal tumors. The laparoscopic technique resulted in 0/15 video port-site recurrences and 9/15 working port-site recurrences, with 14/15 viable intraabdominal tumors. Recurrence at the laparoscopic working port occurred more frequently than in the open (P < 0.02) or laparoscopic video port groups (P < 0.007). No significant difference existed in recurrence between the open incision and the laparoscopic video port (P > 0.5). CONCLUSIONS: Laparoscopic port-site recurrences can be reproduced using the transplantable VX-2 rabbit carcinoma model. In the VX-2 model, trocar recurrence is the result of direct contamination via surgical instrumentation of viable tumor cells. The effect of the pneumoperitoneum or intraperitoneal cytological spillage (indirect contamination) does not have any effect on trocar recurrence. This model can be used to test and improve laparoscopic techniques to minimize the risk of port-site recurrence. Until technological advances have eliminated the risk of trocar recurrences, direct contact between malignant cells and laparoscopic instruments should be performed with caution.
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spelling pubmed-30154442011-02-17 Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions Wilkinson, Neal W. Shapiro, Andrew J. Harvey, Stephen B. Stack, Richard S. Cornum, Rhonda L. JSLS Scientific Papers BACKGROUND: The use of advanced laparoscopy remains controversial in the field of surgical oncology because the potential for port-site recurrence may violate sound oncologic principles. Two mechanisms are theorized to be the cause of port-site recurrences: first, indirect contamination caused by pneumoperitoneum, aerosolization, or intraperitoneal spread, and second, direct contamination by physical trocar seeding. METHODS: A VX-2 carcinoma cell suspension was transferred under the left renal capsule of 31 rabbits with either an open flank incision (16) or laparoscopy (15). Animals were observed for tumor recurrence at the video port, the working port, and the open incision. Intraoperative findings and necropsy were used to document recurrence. RESULTS: The open incision technique resulted in local tumor recurrence in 1/16 animals with 16/16 viable intraabdominal tumors. The laparoscopic technique resulted in 0/15 video port-site recurrences and 9/15 working port-site recurrences, with 14/15 viable intraabdominal tumors. Recurrence at the laparoscopic working port occurred more frequently than in the open (P < 0.02) or laparoscopic video port groups (P < 0.007). No significant difference existed in recurrence between the open incision and the laparoscopic video port (P > 0.5). CONCLUSIONS: Laparoscopic port-site recurrences can be reproduced using the transplantable VX-2 rabbit carcinoma model. In the VX-2 model, trocar recurrence is the result of direct contamination via surgical instrumentation of viable tumor cells. The effect of the pneumoperitoneum or intraperitoneal cytological spillage (indirect contamination) does not have any effect on trocar recurrence. This model can be used to test and improve laparoscopic techniques to minimize the risk of port-site recurrence. Until technological advances have eliminated the risk of trocar recurrences, direct contact between malignant cells and laparoscopic instruments should be performed with caution. Society of Laparoendoscopic Surgeons 2001 /pmc/articles/PMC3015444/ /pubmed/11548826 Text en © 2001 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Scientific Papers
Wilkinson, Neal W.
Shapiro, Andrew J.
Harvey, Stephen B.
Stack, Richard S.
Cornum, Rhonda L.
Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions
title Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions
title_full Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions
title_fullStr Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions
title_full_unstemmed Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions
title_short Port-Site Recurrence Reproduced in the VX-2 Rabbit Carcinoma Model: An In Vivo Model Comparing Laparoscopic Port Sites and Open Incisions
title_sort port-site recurrence reproduced in the vx-2 rabbit carcinoma model: an in vivo model comparing laparoscopic port sites and open incisions
topic Scientific Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015444/
https://www.ncbi.nlm.nih.gov/pubmed/11548826
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