[The status of port-site recurrence]

Since laparoscopic surgery has been applied to cancer, an increased number of secondary tumors implanted in the abdominal wall have been reported. Quality of surgery is paramount in the incidence of port-site recurrences. In large prospective series of laparoscopic colorectal surgery, their incidence (around 0.85%) was similar to that reported in open surgery (0.6 to 1.6%) while it is higher for unapparent gallbladder cancer (around 15%) due to direct wound contamination. Viable tumor cells are seeded by inadequate surgical technique or released by advanced tumors. Tumor cells are carried across the abdominal cavity by peritoneal fluid currents and surgical instruments, not by CO2 pneumoperitoneum. CO2 modifies the morphology of mesothelial cells and inhibits peritoneal macrophages. Differences in retroperitoneal/subserosal/intraluminal tumor xenograft models show that CO2 laparoscopy reduces tumor growth when compared to gasless laparoscopy and laparotomy. The local effects of pneumoperitoneum in the wound might be counteracted by using inert gases such as helium, drug-loaded CO2 or various antiadhesive or cytotoxic agents. In clinical practice, port-site recurrences can be effectively prevented by careful surgical technique and prophylactic wound irrigation.