[Carbon dioxide pneumoperitoneum and peritoneal carcinosis: review]

The aim of this work was to demonstration the relations between CO(2) laparotomy and peritoneal carcinosis. The first part of this review presents published observations of disseminated peritoneal carcinosis after laparoscopy with CO(2) insufflation. The second part deals with the possible effects of CO(2) laparoscopy on the mechanism of carcinosis.

We made a Medline search for cases of peritoneal dissemination after CO(2) laparoscopy. We present here the published results as well as data from comparative studies conducted in humans and animals on the effects of each step of CO(2) laparoscopy on carcinogenesis and the progress of carcinosis.

Most of the published cases on peritoneal dissemination after CO(2) laparoscopy concerned management of ovarian carcinomas where malignancy was not diagnosed before the operation and not treated immediately with laparotomy. The significance of peritoneal dissemination appears to be related to the delay between laparoscopy and laparotomy. No comparative study in humans has been published. For animal studies, it has been difficult to design valid animal modes. Those we present show that laparoscopy has no negative influence on tumor growth but that it may affect peritoneal dissemination. Laparoscopy can participate in diffusion of tumor cells either due to repeated manipulation with contaminated instruments or because of the insufflation itself. These cells can be seeded on traumatized areas of the peritoneum or parietal wall or on the port tracts. The recent work by Volz has proven the effect of CO(2) which can cause a change in the ultra-structure of the peritoneum. This may facilitate peritoneal seeding of the malignant cells. No other study has shown any evidence of increased intraperitoneal tumor growth. Only primary results of post-laparoscopy liver metastasis have diverged. Laparoscopy does not seem to have a negative effect on general immunity, but possible changes in intraperitoneal immunity remain to be elucidated.

Observations concerning peritoneal dissemination are found in cases where CO(2) insufflation was used for laparoscopy, but no studies have proven certain risk greater for laparoscopy than for laparotomy. Maximum precautions must be taken during the management of suspicious ovarian lesions.