Page 37 - TD-2-3

Tumor Discovery

REVIEW ARTICLE
Surgical implantation of malignant cells: A

review of evidence from 1850 to present day

Ajay Vidyarthi*, Kunal Ranjan, Pritesh Rajeev Singh, Shruti Khemka, and
Vinay Venkataramu
Department of Head and Neck Oncology, Mahavir Cancer Sansthan and Research Centre, Patna,
Bihar, India

Abstract

Malignant cells, due to decreased cohesion between them, are more likely to
exfoliate and implant at distant sites during manipulation. This concern was first
expressed by A.G. Gerster in 1885. In this review, we undertook a comprehensive
search of the literature to find the evidence for or against the iatrogenic implantation
of cancer cells. An exhaustive search on PubMed, Medline, Embase, Science Direct,
and Google Scholar yielded 215 relevant publications. The evidence presented
in these publications was extracted and synthesized to draw conclusions for this
review. Diagnostic and therapeutic procedures through fine/wide bore needles have
demonstrated malignant cells in the needle tract but the incidence of recurrences
ranges from 0.0003% to 0.9%. There is evidence of malignant cells adhering to
surgical instruments, and some reports showed that the number cells needed for
successful implantation is 10 – 10 cells in porcine models. A recent prospective
6
7
study on colorectal malignancies has shown that the presence of intraperitoneal
*Corresponding author: cells reduced 2-year survival but was not an independent predictor of the outcome.
Ajay Vidyarthi Port site recurrences have been documented since 1978 but the current consensus
(ajay.oncosurg@gmail.com)
is more inclined to supporting the improper manipulation of tumor, rather than the
Citation: Vidyarthi A, Ranjan K, laparoscopic procedure itself, as the inducer of port site recurrences. Intraperitoneal
Singh PR, et al., 2023, Surgical
implantation of malignant cells: morcellation of leiomyomas and leiomyosarcomas does cause intra-peritoneal
A review of evidence from 1850 to dissemination of tumor cells. Finally, many approaches to preventing implantation
present day. Tumor Discov, have been explored but lavage of operative site with distilled water may stand as the
2(3): 1411.
https://doi.org/10.36922/td.1411 most promising strategy.
Received: July 28, 2023
Accepted: November 13, 2023 Keywords: Iatrogenic implantation; Malignant cells; Fine needle aspiration; Port site
Published Online: November 30, recurrence; Morcellation; Perception and practices
2023
Copyright: © 2023 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution 1. Introduction
License, permitting distribution,
and reproduction in any medium, The risk of surgical implantation of malignant cells was first mentioned by A.G. Gerster
[1]
provided the original work is before the New York Surgical Society in February 1885 and first published by L.H. Lack
properly cited. in 1896 . He documented a series of 35 cases where implantation was the most probable
[2]
Publisher’s Note: AccScience cause of recurrence. Since then, many similar or relevant case reports have emerged,
Publishing remains neutral with starting with the report by Jackson, Ney, and Fisher in 1959 to at least four reports on
regard to jurisdictional claims in
published maps and institutional implantation metastasis in organs ranging from colon, rectum, anal canal, and thyroid
affiliations. in 2022. Based on other case reports, implantation metastasis in tracheotomy sites,

Volume 2 Issue 3 (2023) 1 https://doi.org/10.36922/td.1411