Abdominal insufflation does not cause hematogenous spread of colon cancer.
OBJECTIVE
Previous investigators have suggested that port-site recurrences are possibly a result of abdominal insufflation, forcing viable cancer cells into the circulation to metastasize and thrive in areas of trauma. Using a syngeneic animal cancer model, we tested the hypothesis that pneumoperitoneum increases the incidence of wound metastasis by a blood-borne mechanism.


METHODS
Male BD IX rats (N = 150) were injected intraperitoneally with 2 x 10(5) viable syngeneic 1,2-dimethylhydralazine-induced colon cancer cells (DHD-K12). Animals were divided into three groups: A (abdominal insufflation with 3-cm incision on the back into muscle remote from the peritoneum); B (3-cm back incision alone); and C (control group with 3-cm midline abdominal incision). Three weeks after surgery, the animals were euthanized and autopsied.


RESULTS
In the two groups with back wounds, the incidence of cancer growth at the incision was zero, as demonstrated grossly and by histologic sample (A: 0/47, B: 0/43). In contrast, the autopsied control group had a 42% incidence of metastasis to the wound (25/59). There seemed to be no difference in the distribution of intra-abdominal disease between those rats that underwent insufflation and those that did not.


CONCLUSIONS
It is unlikely that pneumoperitoneum promotes hematogenous wound implantation of free intraperitoneal cancer cells.
Hofstetter
W
W
Division of Colorectal Surgery, University of Southern California, Los Angeles 90033, USA.
Ortega
A
A
Chiang
M
M
Brown
B
B
Paik
P
P
Youn
P
P
Beart
R W
RW
D000818:Animals; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery; D007327:Insufflation; D008297:Male; D009366:Neoplasm Seeding; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D051381:Rats