Tumor seeding following laparoscopy: International survey
Tumor seeding following laparoscopy: International survey
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DOI：
10.1007/s002689900613
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发表时间：
1999-10-01
影响因子：
2.6
通讯作者：
Gutt, C
中科院分区：
文献类型：
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作者：
Paolucci, V;Schaeff, B;Gutt, C
该研究的目的是确定腹腔镜癌症手术期间的肿瘤种植是罕见事件还是该手术的典型并发症。腹腔镜分期和腹内肿瘤治疗在胃肠病学、妇科和普通外科领域不断增加。总共向外科部门主席、德国外科学会、瑞士腹腔镜和胸腔镜外科协会以及奥地利微创外科学会的成员邮寄了 1052 份调查问卷，要求他们列出其部门在腹腔镜检查后对不明显或已知恶性肿瘤进行肿瘤种植的经验。有 607 名（57.7%）外科医生报告了总共 117,840 例腹腔镜胆囊切除术、409 例偶发胆囊癌和 412 例腹腔镜结直肠癌患者。据报道，共有 109 名患者因腹腔镜手术而出现肿瘤复发。 409 名患者中，有 70 名患者 (17.1%) 在腹腔镜胆囊切除术中发现不明显胆囊癌的中位复发时间为 180 天。 8 例（11.5%）胆囊取出时使用了保护性塑料袋。胆囊切除术后中位 120 天，发现 6 名无端口部位转移的患者患有弥漫性腹膜癌病。在 412 例结直肠癌腹腔镜检查中，报告了 19 例 (4.6%) 肿瘤种植病例，其中 16 例 (3.9%) 记录了腹腔镜检查后中位 196 天的端口部位和疤痕复发。肿瘤标本完整，7例采用塑料袋提取。据报道，14 名患者在腹腔镜检查后平均 70 天出现套管针部位转移，原因是不同的不明显或已知的恶性肿瘤。腹腔镜检查癌症后发生腹部转移的可能性高于开腹手术。完整的手术标本和使用塑料取出袋并不能排除端口部位复发的风险。这些事实以及少数腹腔内恶性肿瘤病例中早期出现的腹膜癌似乎证实了腹腔内肿瘤细胞播种和植入的特定腹腔镜风险。
The aim of the study was to determine if tumor seeding during laparoscopic surgery for cancer is a rare event or a typical complication of this procedure. Laparoscopic staging and treatment of intraabdominal tumors is increasing in gastroenterology, gynecology, and general surgery. A total of 1052 questionnaires were mailed to surgical department chairmen, members of the German Society of Surgery, Swiss Association for Laparoscopic and Thoracoscopic Surgery, and Austrian Society of Minimal Invasive Surgery asking them to list their department's experience with tumor seeding after laparoscopy for nonapparent or known malignancy. There were 607 (57.7%) surgeons who reported a total of 117,840 laparoscopic cholecystectomies, 409 incidental gallbladder carcinomas, and 412 laparoscopies on patients with colorectal carcinoma. Altogether 109 patients who developed tumor recurrence in connection with laparoscopic surgery have been reported. Port-site recurrence was identified in 70 of 409 patients (17.1%) with a median of 180 days following laparoscopic cholecystectomy for nonapparent gallbladder carcinoma. Tn 8 cases (11.5%) a protective plastic bag had been used for gallbladder retrieval. Six patients without port-site metastases were found to have a diffuse peritoneal carcinomatosis a median of 120 days after cholecystectomy. Of 412 laparoscopies for colorectal cancer, 19 cases (4.6%) of tumor seeding have been reported, 16 of which (3.9%) had documented port-site and scar recurrences a median of 196 days after laparoscopy. The tumor specimen was intact, and a plastic bag was used for extraction in seven cases. In 14 patients trocar-site metastases have been reported a median of 70 days after laparoscopy for different nonapparent or known malignancies. The probability of developing abdominal mall metastasis is higher after laparoscopy for cancer than after open surgery. An intact surgical specimen and the use of a plastic retrieval bag do not exclude the risk of port-site recurrences. These facts and the early appearance of peritoneal carcinosis in a few cases of intraabdominal malignancies seem to confirm a specific laparoscopic risk for intraperitoneal tumor cell seeding and implantation.