Efficacy of surgical measures in preventing port-site recurrences in a porcine model.
BACKGROUND
Port-site recurrences are serious complications of laparoscopy performed for cancer. Incidences reported in the literature vary between 0% and 21%, suggesting an influence of the surgeon.


METHODS
The aim of this experimental, prospective, randomized, single-blind study was to investigate the influence that the quality surgery has on the incidence of port-site recurrences. After a 12-mmHg carbon dioxide (CO2) pneumoperitoneum was created, 10(7) human HeLa cell were injected into the peritoneal cavity of 18 pigs, creating a xenogeneic tumor. Laparoscopic sigmoid resections then were performed using four trocars and a transanal double-stapling technique. The following protective measures were applied in nine animals: trocar fixation, prevention of gas leaks, rinsing of instruments with povidone-iodine, minilaparotomy protection, rinsing of trocars before removal, peritoneal closure, and rinsing of all wounds with povidoneiodine. Surgeons and type of procedures were randomized. After 4 weeks, the animals were killed and all portsites excised. Blinded immunohistologic analysis with antihuman pancytokeratin antibody was performed.


RESULTS
Tumor recurrence was present in 23 of 36 port sites (63.8%) in the control group, but only in 5 of 36 port sites (13.8%) in the group that received protective measures (p = 0.002; Fisher's exact test). No peritoneal carcinosis nor anastomotic recurrences were observed.


CONCLUSIONS
These results strongly suggest that the quality of surgical technique has an influence on the incidence of port-site recurrences. From now on, we propose to use these protective measures routinely in cancer laparoscopy.
Schneider
C
C
Department of Surgery and Pathology, University of Erlangen, Germany.
Jung
A
A
Reymond
M A
MA
Tannapfel
A
A
Balli
J
J
Franklin
M E
ME
Hohenberger
W
W
Köckerling
F
F
D000818:Animals; D004195:Disease Models, Animal; D006367:HeLa Cells; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009366:Neoplasm Seeding; D011322:Primary Prevention / Q000379:methods*; D011336:Probability; D012016:Reference Values; D012680:Sensitivity and Specificity; D012811:Sigmoid Neoplasms / Q000473:pathology* / Q000601:surgery*; D018709:Statistics, Nonparametric; D013552:Swine