title: Tumor proliferative index is higher in mice undergoing laparotomy vs. CO2 pneumoperitoneum.
abstract: OBJECTIVE
  Our laboratory has previously shown that tumors are more easily established and grow larger after laparotomy vs. laparoscopy. The purpose of this study was to better characterize these differences in tumor growth by assessing tumor cell proliferation via the proliferating cell nuclear antigen assay, which has been shown to be a reliable marker of cellular proliferation.
  
  
  METHODS
  Female C3H/He mice (N = 40) were inoculated intradermally in the dorsal skin with 10(6) cultured mouse mammary carcinoma cells <1 hour before interventions. Anesthesia control mice underwent no procedure. Laparotomy group mice had a midline incision from xiphoid to pubis that was closed after 20 minutes. Insufflation group mice underwent CO2 pneumoperitoneum (4-6 mmHg) for 20 minutes. On postoperative Day 6, tumors were excised from one-third of the mice in each group, and from the remaining mice on postoperative Day 12. Sections were made and stained immunohistochemically for proliferating cell nuclear antigen, and the proliferative index of each tumor was determined by taking the average of proliferating cell nuclear antigen-positive cells in five high-power fields (x450), counted in a blinded fashion with the aid of an optical grid.
  
  
  RESULTS
  On postoperative Day 6, the mean proliferative index for the laparotomy group was significantly higher than those for both the insufflation (P < 0.04) and the control (P < 0.001) groups. Of note, the proliferative index of the insufflation group was significantly higher than that of the control (P < 0.01) group. Similarly, on postoperative Day 12, the mean proliferative index for the laparotomy group was significantly higher than for both the insufflation (P < 0.05) and the control (P < 0.005) groups. The proliferative index in the insufflation group was also significantly higher than that of the control (P < 0.04) group.
  
  
  CONCLUSIONS
  We have demonstrated that there is a significantly higher rate of tumor cell proliferation with the mouse mammary carcinoma cell tumor line after laparotomy than after pneumoperitoneum or anesthesia alone at two postoperative times. Additionally, insufflation alone increases postoperative tumor cell proliferation but to a lesser extent than laparotomy. The mechanism underlying these findings is unclear.
authors.affiliation: Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Lee
authors.forename: J C
authors.initials: JC
authors.lastname: Southall
authors.forename: J D
authors.initials: JD
authors.lastname: Allendorf
authors.forename: M
authors.initials: M
authors.lastname: Bessler
authors.forename: R L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D000818:Animals; D002245:Carbon Dioxide; D005260:Female; D007813:Laparotomy; D008325:Mammary Neoplasms, Experimental / Q000473:pathology*; D051379:Mice; D008809:Mice, Inbred C3H; D011028:Pneumoperitoneum, Artificial; D011184:Postoperative Period; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis
chemical_list: D018809:Proliferating Cell Nuclear Antigen; D002245:Carbon Dioxide