This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (5)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Colon Cancer  • Surgical Oncology  • Gastrointestinal Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Carsten N. Gutt, MD; Zun-Gon Kim, MD; Peter Schemmer, MD; Lukas Krähenbühl, MD; Claus-Georg Schmedt, MD

Arch Surg. 2002;137:1408-1412.

Background  The oncologic feasibility of laparoscopic surgery for the cure of colorectal cancer is under debate. The effect of laparoscopic colorectal cancer resection on hepatic tumor spread has not yet been clarified.

Hypothesis  Laparoscopic surgery affects cell-mediated immune response and hepatic tumor spread dependent on intraperitoneal insufflation.

Methods  Thirty WAG/Rij rats were randomized into 3 operative groups: carbon dioxide (CO₂) laparoscopy (n = 10), "gasless" laparoscopy (n = 10), and laparotomy (n = 10). To induce liver metastases, 50 000 CC531 colon carcinoma cells were injected into the portal vein during either laparoscopy or laparotomy. Twenty-eight days after injection, specimens were explanted, sectioned, and examined immunohistochemically for CC531 tumor cells (monoclonal antibody CC52), CD44v5, v6 (monoclonal antibody OX49), and Kupffer cells (monoclonal antibody HIS36). For quantification, a morphometric analysis system was applied. Data were analyzed using the Kruskal-Wallis, Dunn, and Holm tests.

Results  No statistically significant differences in hepatic tumor growth were found between CO₂ laparoscopy and laparotomy (P = .37). However, compared with CO₂ laparoscopy and laparotomy, a significant decrease in intrahepatic tumor growth was found after gasless laparoscopy (P = .02). Kupffer cells had significantly decreased after CO₂ laparoscopy and laparotomy compared with after gasless laparoscopy (P<.001 and P = .002, respectively). CD44v5, v6 expression was significantly increased after CO₂ laparoscopy and laparotomy compared with after gasless laparoscopy (P = .002 and P = .05, respectively).

Conclusions  Hepatic resistance to tumor growth is best preserved by gasless laparoscopy as opposed to CO₂ laparoscopy or laparotomy. The amount of intra-abdominal pressure with circulatory changes rather than the used gas may explain this finding. On the other hand, conventional laparoscopy vs laparotomy did not preserve hepatic immune function.

From the Department of General and Visceral Surgery, Ruprechts-Karls-University, Heidelberg, Germany (Drs Gutt, Kim, Schemmer, and Schmedt); and Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland (Dr Krähenbühl).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Enhanced Tumour Growth and Impaired Cellular Antitumoural Defence in Hepatic Colorectal Carcinoma Metastasis in Rats after Laparoscopy Compared to Open Surgery
Inderbitzin et al.
Ann. Surg. Oncol. 2008;15:1239-1248.
ABSTRACT | FULL TEXT  

Overcoming Reduced Hepatic and Renal Perfusion Caused by Positive-Pressure Pneumoperitoneum
Bickel et al.
Arch Surg 2007;142:119-124.
ABSTRACT | FULL TEXT