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Intraperitoneal tumor growth is influenced by pressure of carbon dioxide pneumoperitoneum
P Wittich1, E W Steyerberg, S H Simons
1Department of Surgery, University Hospital Rotterdam-Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Background:
Several studies have indicated that the carbon dioxide (CO(2)) pneumoperitoneum during laparoscopy plays a role in the pathogenesis of port-site metastases. An experimental animal study was performed to investigate the impact of various pneumoperitoneum pressures on peritoneal tumor growth.
Methods:
In this study, 36 male WAG rats were randomized into three groups; two groups with different pneumoperitoneum pressures (16 mmHg and 4 mmHg) and one group of gasless controls. After a pneumoperitoneum of 0.5 x 10(6) ml was established, 531 tumor cells were injected intra-abdominally and the pneumoperitoneum was maintained for 60 min. Peritoneal tumor growth was assessed on day 11 at autopsy.
Results:
Peritoneal tumor growth in the 16-mmHg group was significantly greater than in the 4-mmHg group (p = 0.039) and the gasless group (p = 0.004).
Conclusions:
High-pressure CO(2) pneumoperitoneum stimulates intra-abdominal tumor growth. The use of low insufflation pressures in laparoscopic cancer surgery should be considered.