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Tumor Discovery Surgical implantation of malignant cells

laparotomy scars, skin graft donor sites, and laparoscopic and two meta-analyses. Figure 1 presents a summary of
port sites was also reported. Implantations have also been the above-mentioned results, and Figure 2 summarizes the
reported in craniotomy scars of meningiomas. In light of results from search of cross-references.
the accumulating evidence, we aimed to review both past
and present literature that supports iatrogenic implantation 4. Discussion
of malignant cells as the one of the triggers of metastasis. 4.1. Modes of iatrogenic implantation
In this review, we considered 109 case reports and may
have missed a few others which were published in non- A recurrent growth of cancer cells can be suspected of
indexed journals. In our clinical practice, we have received being iatrogenic when a tumor sharing the same histology
complaints for invoking metastasis in these cases due to as the original cancer occurs at a site distant from the
our careless technique, which prompted us to carry out a field of intervention or outside the lymphatic basin of
search of the literature for evidence on this phenomenon. the primary tumor. The most probable explanation for
this phenomenon is the transfer of cells through surgical
2. Methods supplies, lavage water, etc. These recurrences have been
reported at sites of tracheostomy and percutaneous
A comprehensive search on PubMed, Medline, Embase, gastrostomy in head-and-neck cancers, at graft donor
Science Direct, and Google Scholar was conducted. The sites in sarcomas, on abdominal incision scars, and at
MeSH terms used included “cancer cell implantation,” laparoscopic and thoracoscopic port sites. They have also
“implantation of malignant cells,” “iatrogenic implantation been reported in the needle tract of fine/wide bore needle
tumor cells,” “cancer seeding instruments,” “residual aspiration sites.
tumor cells wash water,” “residual tumor cells surgical
instruments,” “residual tumor cells wounds,” and “skin/ Common modes of implantation of malignant cells in
cutaneous recurrence.” Publications published from 1885 present-day scenario include:
to 2022 were targeted in this literature search. (1) Implantation through surgical instruments and supplies.
(2) Implantation during diagnostic/therapeutic
All results were examined for relevance by briefly procedures using fine/wide bore needles.
checking the title of publications. The publications were (3) Intraperitoneal and port site implantation.
sorted according to type and year of publication. All relevant (4) Implantation due to intraperitoneal morcellation of
publications were selected from the list after a quick review of tumor.
the abstracts by two authors. Finally, evidence was extracted The ensuing review will discuss the history of implantation
from the text and synthesized by two other authors. The and the evidence for or against the above modes of
final manuscript was edited by two authors. This review implantation, and examine the efficacy of preventive
is prepared and written as per the PRISMA statement for measures.
reporting systematic reviews and meta-analyses .
[3]
4.2. History
3. Results
Charles Ryall first pointed out the danger of implantation
[4]
The search yielded 53,087 results of which 175 seemed of cancers cells and advocated changing of drapes,
relevant. When sorted by date of publication, another instruments, etc. Cole et al. studied suture line recurrence
[5]
14 were found irrelevant, leaving behind 161 relevant in colorectal cancers after resection and noted that smears
studies. Out of the filtered publications, there were 94 case taken from the lumen outside the ligature used to isolate
reports/case series, 22 animal experiment studies, and the resected segment of colon showed no cells as opposed
13 studies on human subjects. Seven human studies were of to smears from inside the ligature. A retrospective study
prospective nature, seven were retrospective (a few studies of gastric cancer patients undergoing curative surgery
included animal experiments and retrospective observation from 1931 to 1957 showed wound recurrence in 1.9% of
in humans), and one was cross-sectional. There were 16 569 patients . In addition, Haverback and Smith proved
[6]
[7]
reviews and one survey. No studies reporting randomized that cancer cells can be transplanted by suture in mouse
or non-randomized trials were found among the selected experiments while tumor cells have been demonstrated
publications. A further search of cross-references yielded to adhere to surgical knives . During this period, many
[8]
another 67 studies, of which 12 were irrelevant and one was a animal experiments have been conducted to demonstrate
duplicate study, leaving behind 54 relevant studies. There were the implantation of cancer cells as well as several methods
four trials, five prospective and three retrospective studies, of prevention have been introduced. A comprehensive
eight cross-sectional studies, four animal experiments, two review of the evidence was published by Colin Thomas Jr
[9]
human experiments, 10 case reports/case series, 16 reviews, in 1961. It was found that two to three million Ehrlich’s

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