Increased tumor growth and spread after laparoscopy vs laparotomy: influence of tumor manipulation in a rat model.
BACKGROUND
The use of laparoscopy for assessment and treatment of malignant tumors remains controversial. The aim of this study was to evaluate the impact of tumor manipulation during laparoscopy compared with that of conventional laparotomy on growth and spread of an intraperitoneal tumor in the rat in a randomized, controlled trial.


METHODS
Thirty 2-month-old male Lewis rats received a single-site intrapancreatic inoculation of a ductal adenocarcinoma. Fourteen days after cancer implanting, two groups of six animals each underwent a laparotomy (30 min 6 mmHg CO2 pneumoperitoneum). The tumor was manipulated in the one group, and exclusively visualized in the other. In two other groups, a midline laparotomy with (n = 6) or without (n = 6) tumor manipulation was performed. Animals in the control group (n = 6) underwent no procedure. Tumor volume, tumor mass, local regional invasion incidence, lymph node involvement, and liver and lung metastases were evaluated on 28-day tumors.


RESULTS
No difference in tumor growth and spread was observed between laparoscopy and laparotomy when tumor manipulation was not carried out. Tumor manipulation increased tumor growth significantly in the laparotomy group, but not in the laparoscopy one. Tumor metastases were correlated to tumor growth and increased significantly after manipulation in both groups. There was no port-site or conventional wound seeding in either the surgical procedure.


CONCLUSIONS
This study showed that manipulation is the main factor acting on tumor dissemination in both laparoscopy and laparotomy. Laparoscopic surgery had a beneficial effect on local tumor growth compared with laparotomy in the case of tumor manipulation. This beneficial effect of laparoscopic surgery may be related to a better preservation of immune function in the early postoperative period.
Mutter
D
D
European Institute of Telesurgery (IRCAD-EITS), Department of DigestiveSurgery, Clinique Chirurgicale A Hôpitaux Universitaires, 1, place del l'Hôpital, F-6700 Strasbourg, France.
Hajri
A
A
Tassetti
V
V
Solis-Caxaj
C
C
Aprahamian
M
M
Marescaux
J
J
D000704:Analysis of Variance; D000818:Animals; D004195:Disease Models, Animal; D007107:Immune System / Q000502:physiology; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D010190:Pancreatic Neoplasms / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000556:secondary; D011897:Random Allocation; D051381:Rats; D011917:Rats, Inbred Lew; D018709:Statistics, Nonparametric