Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy.
OBJECTIVE
CO₂ leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy (HIPPC).


METHODS
Sixty-two patients with malignant ascites induced by gastrointestinal or ovarian cancer were divided into two groups to receive either B-ultrasound-guided or laparoscopically-assisted HIPPC. Clinical efficacy was assessed from the objective remission rate (ORR), the Karnofsky Performance Status (KPS) score, and overall survival. The incidence of port-site metastasis was compared between the two groups.


RESULTS
Patients in the B-ultrasound (n=32) and laparoscopy (n=30) groups were comparable in terms of age, sex, primary disease type, volume of ascites, and free cancer cell (FCC)-positive ascites. After HIPPC, there were no significant differences between the B-ultrasound and laparoscopy groups in the KPS score change, ORR, and median survival time. The incidence of port-site metastasis after HIPPC was not significantly different between the B-ultrasound (3 of 32, 9.36%) and laparoscopy (3 of 30, 10%) groups, but significantly different among pancreatic, gastric, ovarian, and colorectal cancer (33.33, 15.79, 10.00, and 0.00%, p<0.001).


CONCLUSIONS
The chimney effect may not be the key reason for port-site metastasis after laparoscopy. Other factors may play a role, including the local microenvironment at the trocar site and the delivery of viable FCCs (from the tumor or malignant ascites) to the trauma site during laparoscopic surgery.
Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China. bamingchen@126.com.
Ming Chen
MC
Ba
Department of Pharmacy, Guangzhou Dermatology Institute, Guangzhou, P.R. China. 798587414@qq.com.
Hui
H
Long
Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China.
Xiang Liang
XL
Zhang
Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China.
Yuan Feng
YF
Gong
Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China.
Zhao Fei
ZF
Yan
Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China.
Shuai
S
Wang
Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China.
Yun Qiang
YQ
Tang
Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China.
Shu Zhong
SZ
Cui
D000230:Adenocarcinoma / Q000209:etiology / Q000556:secondary*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology; D010529:Peritoneal Cavity; D010534:Peritoneal Neoplasms / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D012074:Remission Induction; D013525:Surgical Instruments; D018084:Ultrasonography, Interventional / Q000379:methods*
D000970:Antineoplastic Agents
B-ultrasound; Chimney effect; HIPPC; laparoscopy; port-site metastasis