Port-Site and Wound Recurrences in Cancer Surgery : Incidence - Pathogenesis - Prevention

During the past 9 years, reports of 'port-site' deposits following laparoscopic surgery for malignancy, especially laparoscopic resection of colonic cancer, have cast a shadow on the wisdom of the laparoscopic approach in the surgical man­ agement in patients with cancer. Those reports of port-site deposits, some 90 cases reported in the literature up to 1999, have opened a 'can of worms' and highlighted the scarcity of our knowledge on cancer cell migration from solid tu­ mors and the factors that underlie their successful implantation in surgical wounds both in the presence and absence of a positive pressure pneumoperito­ neum. The jury is out even in relation to the effect of the healing surgical access wound - do the biochemical and cellular repair processes and the associated growth factors enhance or prevent implantation of exfoliated viable tumor cells? Whatever the answer to this question, it is clear that tumor cells do implant in healing surgical wounds and the key question is whether this is facilitated by lap­ aroscopic surgery with CO pneumoperitoneum compared to the traditional 2 surgical exposure. It is known that tumors shed malignant cells into the blood stream, the peritoneal cavity and in the case of hollow organs, intraluminally. Equally there is good evidence that surgical and instrumental manipulation of tumors induce exfoliation of viable tumor cells. Front Matter....Pages I-XV Definition of Port-Site and Wound Recurrences in Cancer Surgery....Pages 1-5 A Case Report....Pages 6-7 Abdominal Wall Recurrences in Open Surgery....Pages 8-11 Port-Site Recurrences in Laparoscopic Surgery....Pages 12-20 Port-Site Recurrences in Thoracoscopic Surgery....Pages 21-25 Port-Site Recurrences in Colon and Rectal Cancers: Randomized Studies....Pages 26-28 Pathogenesis: Tumor Cell Lines and Application in Experimental Animal Studies....Pages 29-43 Pathogenesis: Transportation of Tumor Cells in Animal Studies....Pages 44-51 Pathogenesis: Local Effects in the Wound in Animal Studies....Pages 52-59 Pathogenesis: Immunological Aspects of Animal Studies....Pages 60-68 Pathogenesis: Free Viable Cancer Cells and Cancer Cell Liberation in Clinical Studies....Pages 69-73 Pathogenesis: Transportation of Tumor Cells in Clinical Studies....Pages 74-80 Pathogenesis: Immunological Aspects of Clinical Studies....Pages 81-90 Mechanical Means For Prevention of Trocar Site Cancer Implantation....Pages 91-97 Prevention of Port-Site Recurrences: Chemical Measures....Pages 98-103 Prevention of Port-Site Recurrences: Gasless Laparoscopy and Other Gases....Pages 104-111 Prevention of Port-Site Recurrences: Role of Therapeutic Pneumoperitoneum....Pages 112-117 Treatment of Port-Site Recurrences....Pages 118-123 Illustrated Practical Notes for the Surgeon....Pages 124-128 Conclusions and Perspectives....Pages 129-132 Back Matter....Pages 133-136 This is the most talked about subject in laparoscopic surgery today. At every meeting in surgery and oncology at least one or two sections involve this topic. This book allows the reader an organized insight into the different pathogenic mechanisms of port-site recurrences, notably as to where the cells from which the secondary tumour arises come from, how they are dispersed, and how local effects in the port-site wound can favor implantation. Moreover, the book contains practical well illustrated guidelines to show preventive measures applicable by any surgeon. These can reduce substantially the incidence of port-site recurrence, allowing for a safer application of minimally invasive surgery in cancer. All or most surgical units working in this field world wide have contributed to this book