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Reduction of abdominal wall blood flow by clamping or carbon dioxide insufflation increases tumor growth in the abdominal wall: an experimental study in rats.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
2005 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 19, no 5, 720-723 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We have previously demonstrated that there is a reduction of blood flow in the abdominal wall in rats insufflated with air concomitant with an increase in tumor growth. The present study was designed to examine whether a reduction of blood flow achieved by clamping or insufflation with carbon dioxide (CO(2)) would increase tumor growth in the abdominal wall. METHODS: In the first part of the experiments, laser Doppler blood flow of both rectus muscles was measured in 16 Wistar Fu rats. The left rectus muscle was clamped to reduce blood flow, and 5 x 10(4) adenocarcinoma cells were injected into both rectus muscles. Clamping was maintained for 45 min. In the second part, 22 rats had 5 x 10(4) adenocarcinoma cells injected into the rectus muscle and blood flow was measured. The experimental group (n = 11) was insufflated with CO(2) at 10 mmHg for 45 min; the control group (n = 11) was not insufflated. After 9 days, tumor weight and volume were analyzed. RESULTS: Clamping caused a 69% reduction of blood flow (p < 0.001), whereas no reduction was registered on the nonclamped side. Tumor weight (p = 0.028) and volume (p = 0.030) were increased on the clamped side. The insufflation of CO(2) caused a 71% reduction of blood flow, whereas no reduction was registered in the control group. Tumor weight (p = 0.006) and volume (p = 0.006) were increased in the insufflated group. CONCLUSION: Clamping, as well as CO(2) insufflation, causes a significant reduction of blood flow in the abdominal wall, which seems to increase tumor growth at the same site.

Place, publisher, year, edition, pages
2005. Vol. 19, no 5, 720-723 p.
Keyword [en]
Abdominal Neoplasms/*pathology, Abdominal Wall/*blood supply, Adenocarcinoma/*pathology, Animals, Carbon Dioxide/administration & dosage/*adverse effects, Constriction, Disease Progression, Injections; Intramuscular, Insufflation/adverse effects, Ischemia/*etiology, Laser-Doppler Flowmetry, Neoplasm Transplantation, Pneumoperitoneum; Artificial/*adverse effects, Pressure, Random Allocation, Rats, Rats; Inbred WF, Rectus Abdominis/*blood supply, Single-Blind Method, Tumor Burden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-6039DOI: 10.1007/s00464-004-9061-0PubMedID: 15798898OAI: oai:DiVA.org:umu-6039DiVA: diva2:145707
Available from: 2007-12-05 Created: 2007-12-05 Last updated: 2017-12-14Bibliographically 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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