Experimental assessment of the risk of tumor recurrence after laparoscopic surgery

• Published in: Surgery 1998-04, Vol.123 (4), p.427-431
• Main Authors: Le Moine, Marie-Christine, Navarro, Francis, Burgel, Jean-Stéphane, Pellegrin, André, Khiari, Abdel Raouf, Pourquier, Didier, Fabre, Jean-Michel, Domergue, Jacques
• Format: Article
• Language: English
• Subjects: Animals; Biological and medical sciences; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Gastroenterology. Liver. Pancreas. Abdomen; Laparoscopy - methods; Male; Medical sciences; Neoplasm Staging; Random Allocation; Rats; Rats, Inbred Strains; Recurrence; Risk Assessment; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Tumors
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(98)70164-3

Background: The aim of this experimental study was to evaluate the risk of tumor recurrence after laparoscopic cecal resection (LCR) of colonic carcinoma in the rat. Methods: The experimental cancer consisted of one million cells (DHK/K12), incorporated in an extracellular matrix, placed and secured to the cecal serosa in 110 BD9 rats. Four weeks later, all animals were reoperated through a laparotomy to control tumor growth, and animals with diffuse carcinomatosis were excluded. Eligible animals were randomized either to laparoscopic cecal resection (group LCR, n = 10), to open resection (group OCR, n = 13), or to a control group without resection (group C, n = 13). Resection was always considered as macrocopically complete. All animals were killed 4 weeks after the resection to determine the tumor recurrence and quantify carcinomatosis. Results: We noted diffuse carcinomatosis in 70% of rats in groups C and LCR versus 23% in group OCR ( p = 0.038). For tumors noted as S- (not extending outside the serosa), diffuse carcinomatosis was observed in all animals of group C (3 of 3), in 6 of 8 in group LCR, and 0 of 6 in group OCR ( p = 0.004). The rate of port site or incisional metastases was not significantly different between groups. Conclusions: These preliminary results demonstrated the deleterious impact of the laparoscopy for resection of large bowel malignancy. LCR increased significantly the incidence of a diffuse carcinomatosis even when performed for locally noninvasive tumors (S-). (Surgery 1998;123:427-31.)