Influence of peritoneal factors on port-site metastases in a xenograft ovarian cancer model.
OBJECTIVE
We determine the main physical effects of pneumoperitoneum on tumour dissemination and port-site metastases occurrence.


METHODS
A prospective randomised study in rats.


METHODS
A human ovarian cancer cell line (IGR-OV1) was xenografted in nude rats. Seven days after cancer inoculation, surgery was performed. Rats were randomised in two main groups and underwent either: gasless laparoscopy (n = 20) CO2 laparoscopy with pneumoperitoneum pressure at 4 mmHg (n = 20), or 8 mmHg (n = 20) with in each case, increasing operative duration: 30,60,90 or 120 minutes (five rats for each time). Animals were killed seven days after the intervention.


METHODS
Tumour dissemination and frequency of port-site metastases.


RESULTS
Tumour dissemination was not influenced by gas pressures or duration of procedure. The rate of rats with at least one port-site metastasis (one or two) was similar in all groups: gasless: n = 10/20; 4 mmHg CO2: 5/20; 8 mmHg CO2: 7/20,(P = 0.26). The number of port-site metastases were significantly higher in the gasless group compared with the 4 mmHg CO2 group (15/40 (37.5%) vs 5/40 (12.5%), P = 0.01). Difference was not significant between the 8mmHg group and the gasless group (9/40(22.5%) vs 15/40(37.5%), P = 0.14) or the 4mmHg group (9/40(37.5%) vs 5/40 (12.5%), P = 0.24). Duration of procedures had no significant influence on port-site metastases rate (P > 0.05).


CONCLUSIONS
Unlike previous animal studies, port-site metastases were more frequent with gasless laparoscopy than with CO2 pneumoperitoneum. Local peritoneal factors could play an important role in port-site metastases mechanism.
Agostini
A
A
Department of Gynecology and Obstetrics, Maternity Hospital, Marseille, France.
Robin
F
F
Aggerbeck
M
M
Jaïs
J P
JP
Blanc
B
B
Lécuru
F
F
D000818:Animals; D002245:Carbon Dioxide / Q000627:therapeutic use; D005260:Female; D010535:Laparoscopy / Q000009:adverse effects*; D023421:Models, Animal; D009366:Neoplasm Seeding; D009368:Neoplasm Transplantation / Q000379:methods; D010051:Ovarian Neoplasms / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D051381:Rats; D014183:Transplantation, Heterologous
D002245:Carbon Dioxide