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Port site metastases from gallbladder cancer after laparoscopic cholecystectomy.: Results of a Swedish survey and review of published reports.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
1999 (English)In: European Journal of Surgery, ISSN 1102-4151, Vol. 165, no 3, 215-222 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the incidence of port site metastases from unsuspected gallbladder cancer after laparoscopic cholecystectomy. DESIGN: Retrospective national multicentre study, 1991-94. SETTING: All 8 university and 24 central hospital, Sweden. SUBJECTS AND INTERVENTIONS: All 32 hospitals were interviewed by means of a written questionnaire. The registers of all Swedish Oncological Centres and the registers of the National Board of Health and Welfare were checked for reported cases of gallbladder cancer and surgical classification codes for cholecystectomy. To detect laparoscopic interventions incorrectly registered as open operations, all cholecystectomies registered as open were matched against the Swedish Registry of Laparoscopic Cholecystectomy for the years 1991-93 and all patients records for 1994 were scrutinised. RESULTS: Replies were obtained from 30/32 clinics (94%) and 11976 laparoscopic cholecystectomies were done. Of 447 patients with verified gallbladder carcinoma 270 had their gallbladders removed, 55 (20%) laparoscopically. 9 of these (16%) developed port site metastases and 6 died from their disease at a median of 18 months (range 5-22). Two patients are alive, 54 and 45 months after cholecystectomy. One patient has been lost to follow-up. CONCLUSIONS: Port site metastases from gallbladder cancer may be more common than previously thought. A laparoscopic procedure should not be done if cancer of the gallbladder is suspected.

Place, publisher, year, edition, pages
1999. Vol. 165, no 3, 215-222 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-3853DOI: 10.1080/110241599750007072PubMedID: 10231654OAI: oai:DiVA.org:umu-3853DiVA: diva2:142738
Available from: 2004-04-08 Created: 2004-04-08 Last updated: 2010-08-06Bibliographically approved
In thesis
1. Laparoscopy and tumour growth: a clinical and experimental study
Open this publication in new window or tab >>Laparoscopy and tumour growth: a clinical and experimental study
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: Laparoscopic technique was quickly adopted in general surgery because of less pain, quicker recovery and shorter hospital stay. In the 1990´s several reports on port site metastases restrained the enthusiasm to use laparoscopic surgery in malignant diseases. The numerous reports on port site metastases initiated a debate whether laparoscopic surgery would increase the risk of tumour spread and growth. Personal experience of two patients who devloped port site metastases from an incidental gall bladder cancer (GBC) after laparoscopic cholecystectomy (LC), encouraged us to study the incidence of wound metastases from GBC after laparoscopic and open cholecystectomy (OC). Experimentally we examined whether pneumoperitoneum would increase the risk of tumour development. Several studies had demonstrated that minimally invasive procedures exert a less negative influence on the immune system and may have beneficial effects for cancer patients. We wanted to compare the long term survival after OC and LC and if the occurence of port site metastases had any impact on survival.

Material and methods: A questionnaire was sent out to all major hospitals in Sweden requesting information obout the number of port site metastases encountered 1991-94. Data on all pateints with verfied GBC were obtained from the Swedish Oncological Centres. Data on all patients with GBC registered with surgical codes for cholecystectomy were collected from the National Board of Health and Welfare (EpC). The patient files were scrutinized and long term survival data was achieved (EpC). In the first experiment on Wistar Fu rats, adenocarcinoma cells were injected intraperitoneally in animals insufflated with air, CO2 and not insufflated controls. In the following studies, rats were similarly insufflated with air,CO2 and compared to not insufflated controls. Laser Doppler blood flow in the abdominal wall was concomitantly measured. To study the effect of reduced blood flow, one rectus muscle was clamped and the other not and laser Doppler Blood flow was measured in both rectus muscles. Adenocarcinoma cells were injected into the rectus muscles in all animals at the induction of pneumoperitoneum/clamping.

Results: 14 of 55 patients developed wound metastases from GBC after LC and 12 of 187 after OC. Gallbladder perforation was overrepresented in patients with wound metastases. Improved survival was noted after LC in patients with T3 tumours. Experimentally, air and CO2 equally increased intraperitoneal tumour development, Insufflation with air,CO2 and clamping decreased blood flow in the abdominal wall and increased tumour growth at the same site.

Conclusion: Despite a high rate of wound metastases, LC does not seem to worsen the prognosis of GBC and may even have a positive effect on survival. Perforation of the malignant gallbladder seems to be associated with an increased risk of metastatic formation. In the experimental setting, pneumoperitoneum seems to increase tumour development. Other features of laparoscopic surgery such as decreased blood flow in the abdominal wall may contribute to increased risk of tumour progress.

Publisher
138 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 889
Keyword
Surgery, laparoscopy, tumour growth, metastases, gallbladder cancer, pneumoperitoneum, blood flow, Kirurgi
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-227 (URN)91-7305-613-8 (ISBN)
Public defence
2004-05-14, sal B, 9 tr, Tandläkarhögskolan, Umeå Universitetssjukhus, Umeå, 13:00
Opponent
Supervisors
Available from: 2004-04-08 Created: 2004-04-08 Last updated: 2010-08-06Bibliographically approved

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Lundberg, OweKristoffersson, Anders

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