Topical treatments of laparoscopic port sites can decrease the incidence of incision metastasis.
BACKGROUND
Anecdotal reports of port site tumor recurrence have dampened the enthusiasm for laparoscopic colectomy for cancer. We developed a rat model that creates a high incidence of port site metastasis following laparoscopic intervention. Our goal was to assess the feasibility of minimizing implantations using port site irrigation prior to wound closure.


METHODS
Colon cancer carcinomatosis was established in 46 female BD9 rats using intraperitoneal injections of 10(6) DHD-K12-TRb rat colon cancer cells. This preparation yielded an 81% incidence of port site metastasis in a control group. Laparoscopic sham surgery was performed using four ports and a CO(2) pneumoperitoneum. Four treatment groups were studied by irrigating each port site as follows: Group I, sterile water; group II, normal saline; group III, heparin; group IV, 5-fluorouracil (5-FU). The animals were killed at 4 weeks, and the port sites were examined for tumors.


RESULTS
There were no differences in port site metastasis between controls and groups I, II, and III. The 5-FU group showed a significant decrease (30% vs 81%) in metastasis.


CONCLUSIONS
Port site irrigation with 5-FU at the time of laparoscopy reduces the incidence of port site tumor implantation in a rat colon cancer model. This finding may have utility in patients at high risk of such metastasis who undergo laparoscopy for colon cancer.
Eshraghi
N
N
Department of Minimally Invasive Surgery, Legacy Portland Hospital, Portland, OR 97227, USA.
Swanstrom
L L
LL
Bax
T
T
Jobe
B
B
Horvath
K
K
Sheppard
B
B
Deveney
C
C
D000287:Administration, Topical; D000818:Animals; D003082:Colectomy / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009366:Neoplasm Seeding; D051381:Rats; D012307:Risk Factors
D005472:Fluorouracil