Experimental assessment of the risk of tumor recurrence after laparoscopic surgery.
BACKGROUND
The aim of this experimental study was to evaluate the risk of tumor recurrence after laparoscopic cecal resection (LCR) of colonic carcinoma in the rat.


METHODS
The experimental cancer consisted of one million cells (DHK/K12), incorporated in an extracellular matrix, placed and secured to the cecal serosa in 110 BD9 rats. Four weeks later, all animals were reoperated through a laparotomy to control tumor growth, and animals with diffuse carcinomatosis were excluded. Eligible animals were randomized either to laparoscopic cecal resection (group LCR, n = 10), to open resection (group OCR, n = 13), or to a control group without resection (group C, n = 13). Resection was always considered as macrocopically complete. All animals were killed 4 weeks after the resection to determine the tumor recurrence and quantify carcinomatosis.


RESULTS
We noted diffuse carcinomatosis in 70% of rats in groups C and LCR versus 23% in group OCR (p = 0.038). For tumors noted as S- (not extending outside the serosa), diffuse carcinomatosis was observed in all animals of group C (3 of 3), in 6 of 8 in group LCR, and 0 of 6 in group OCR (p = 0.004). The rate of port site or incisional metastases was not significantly different between groups.


CONCLUSIONS
These preliminary results demonstrated the deleterious impact of the laparoscopy for resection of large bowel malignancy. LCR increased significantly the incidence of a diffuse carcinomatosis even when performed for locally noninvasive tumors (S-).
Le Moine
M C
MC
Department of Digestive Surgery C, Saint Eloi Hospital, Montpellier, France.
Navarro
F
F
Burgel
J S
JS
Pellegrin
A
A
Khiari
A R
AR
Pourquier
D
D
Fabre
J M
JM
Domergue
J
J
D000818:Animals; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D011897:Random Allocation; D051381:Rats; D011919:Rats, Inbred Strains; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors