Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy.
10.3349/ymj.2017.58.3.497
- Author:
Ming Chen BA
1
;
Hui LONG
;
Xiang Liang ZHANG
;
Yuan Feng GONG
;
Zhao Fei YAN
;
Shuai WANG
;
Yun Qiang TANG
;
Shu Zhong CUI
Author Information
1. Intracelom Hyperthermic Perfusion Therapy Center, Cancer Center of Guangzhou Medical University, Guangzhou, P.R. China. bamingchen@126.com
- Publication Type:Original Article
- Keywords:
Chimney effect;
laparoscopy;
B-ultrasound;
HIPPC;
port-site metastasis
- MeSH:
Ascites;
Colorectal Neoplasms;
Drug Therapy*;
Humans;
Incidence;
Karnofsky Performance Status;
Laparoscopy;
Neoplasm Metastasis*;
Ovarian Neoplasms;
Perfusion*;
Surgical Instruments;
Treatment Outcome
- From:Yonsei Medical Journal
2017;58(3):497-504
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: CO₂ leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy (HIPPC). MATERIALS AND METHODS: Sixty-two patients with malignant ascites induced by gastrointestinal or ovarian cancer were divided into two groups to receive either B-ultrasound-guided or laparoscopically-assisted HIPPC. Clinical efficacy was assessed from the objective remission rate (ORR), the Karnofsky Performance Status (KPS) score, and overall survival. The incidence of port-site metastasis was compared between the two groups. RESULTS: Patients in the B-ultrasound (n=32) and laparoscopy (n=30) groups were comparable in terms of age, sex, primary disease type, volume of ascites, and free cancer cell (FCC)-positive ascites. After HIPPC, there were no significant differences between the B-ultrasound and laparoscopy groups in the KPS score change, ORR, and median survival time. The incidence of port-site metastasis after HIPPC was not significantly different between the B-ultrasound (3 of 32, 9.36%) and laparoscopy (3 of 30, 10%) groups, but significantly different among pancreatic, gastric, ovarian, and colorectal cancer (33.33, 15.79, 10.00, and 0.00%, p<0.001). CONCLUSION: The chimney effect may not be the key reason for port-site metastasis after laparoscopy. Other factors may play a role, including the local microenvironment at the trocar site and the delivery of viable FCCs (from the tumor or malignant ascites) to the trauma site during laparoscopic surgery.
