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Does gas insufflation during oncologic laparoscopic surgery cause dissemination of malignant cells?
1Gynecologic Oncology Department, Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel
2Department of Pathology, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel
3Urology Department, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel
DOI: 10.22514/ejgo.2023.017 Vol.44,Issue 2,April 2023 pp.14-18
Submitted: 22 November 2022 Accepted: 17 February 2023
Published: 15 April 2023
*Corresponding Author(s): Yossi Tzur E-mail: yossitzur@gmail.com
To investigate whether benign or malignant cells are present in gas evacuated from the abdominal cavity during oncologic laparoscopic surgery. Thirty patients were included in this prospective observational study conducted at an academic, tertiary medical center. Fifteen patients underwent a laparoscopic staging procedure for high-grade uterine adenocarcinoma and 15 patients underwent laparoscopic nephrectomy for suspected renal cell carcinoma. The gas evacuated during laparoscopy was passed through a filter in order to capture any aerosolized cells formed during surgery. After surgery, the filter was rinsed backwards with 50 mL of saline, and the fluid was centrifuged and sent for cytological evaluation. The primary outcome was presence of benign or malignant cells in the rinsed fluid. Neither benign nor malignant cells were identified in evacuated gas in 29 cases (96.7%). In one endometrial cancer case, where macroscopic extra-uterine pelvic metastases were encountered intra-operatively, atypical epithelial cells were found in collected fluid of rinsed gas filter. Gas insufflation during laparoscopy for gynecologic and urologic malignancies apparently does not cause aerosolization and dissemination of malignant cells. However, laparoscopic surgery itself may cause cell spread possibly via surgical instruments when macroscopic, extra-organ tumor spread is encountered, the clinical significance of which remains undetermined.
Minimal invasive surgery; Gynecologic oncology; Urologic oncology; Dissemination; Tumor cells; Safety
Yossi Tzur,Ido Laskov,Asaf Aizic,Ziva Aharon,Avi Beri,Limor Gortzak-Uzan,Dan Grisaru,Nadav Michaan. Does gas insufflation during oncologic laparoscopic surgery cause dissemination of malignant cells?. European Journal of Gynaecological Oncology. 2023. 44(2);14-18.
[1] Sellers GJ, Whelan RL, Allendorf JD, Gleason NR, Donahue J, Laird D, et al. An in vitro model fails to demonstrate aerosolization of tumor cells. Surgical Endoscopy. 1998; 12: 436–439.
[2] Dorrance HR, Oien K, O’Dwyer PJ. Effects of laparoscopy on intraperitoneal tumor growth and distant metastases in an animal model. Surgery. 1999; 126: 35–40.
[3] Lin F, Pan L, Li L, Li D, Mo L. Effects of a simulated CO2 pneumoperitoneum environment on the proliferation, apoptosis, and metastasis of cervical cancer cells in vitro. Medical Science Monitor. 2014; 20: 2497–503.
[4] Cibula D, McCluggage WG. Sentinel lymph node (SLN) concept in cervical cancer: current limitations and unanswered questions. Gynecologic Oncology. 2019; 152: 202–207.
[5] Champault G, Taffinder N, Ziol M, Riskalla H, Catheline JMC. Cells are present in the smoke created during laparoscopic surgery. British Journal of Surgery. 2005; 84: 993–995.
[6] Ikramuddin S. Detection of aerosolized cells during carbon dioxide laparoscopy. Journal of Gastrointestinal Surgery. 1998; 2: 580–584.
[7] Kong T, Chang S, Piao X, Paek J, Lee Y, Lee EJ, et al. Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer. Journal of Obstetrics and Gynaecology Research. 2016; 42: 77–86.
[8] Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. New England Journal of Medicine. 2018; 379: 1895–1904.
[9] Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2. Journal of Clinical Oncology. 2009; 27: 5331–5336.
[10] Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group LAP2 study. Journal of Clinical Oncology. 2012; 30: 695–700.
[11] Paik ES, Lim MC, Kim M, Kim YH, Song ES, Seong SJ, et al. Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment: ancillary analysis of a Korean gynecologic oncology group study (KGOG 1028). Gynecologic Oncology. 2019; 154: 547–553.
[12] Cusimano MC, Baxter NN, Gien LT, Moineddin R, Liu N, Dossa F, et al. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. American Journal of Obstetrics and Gynecology. 2019; 221: 619.e1–619.e24.
[13] Melamed A, Margul DJ, Chen L, Keating NL, del Carmen MG, Yang J, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. New England Journal of Medicine. 2018; 379: 1905–1914.
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