Page 43 - TD-2-3

Tumor Discovery Surgical implantation of malignant cells

the site of resection be thoroughly washed before moving mice treated with distilled water. Therefore, the authors
on to reconstruction. concluded that a water lavage, although not curative, may
Berger-Richardson et al. investigated the beliefs and delay peritoneal outgrowth and prolong survival of patient.
practices of surgeon regarding glove and instrument The possible role of intraoperative rectal washout has
changes . They conducted a mailed survey among been investigated by Terzi et al. . Local recurrence rates
[55]
[63]
surgeons registered with the College of Physicians and were similar in rectal washout and no washout groups,
Surgeons of Ontario to investigate how surgeons handle and none of the patients developing local recurrence had
gloves and instruments used in cancer resection, the malignant cells on the circular stapler. After reviewing the
strategies used to prevent cancer seeding, and whether they evidence regarding utility of rectal washout and types of
[64]
believe gloves and instruments can be vectors for cancer washout, Okoshi et al. opined that there is insufficient
cell seeding. They found that 52% of the respondents had evidence to recommend one washout solution over another
changed gloves and 40% had changed instruments. The or even that a rectal washout is potent enough to decrease
most commonly cited reasons for such action were “gut the risk for anastomotic recurrence. Nevertheless, a rectal
feeling,” clinical training, and clinical observation. Only wash does not appear to damage the rectum and may be
4% cited evidence as the reason for changing. Surgeons used before anterior resection.
with fellowship training in general surgical oncology or Schneider et al. studied the prevention of port
[65]
breast were more likely to change gloves and instruments site recurrences in a porcine model and concluded that
than surgeons trained in site-specific oncology or without surgical technique has a major influence on recurrence.
training in oncology. These results are in concordance with results of human
Caudill et al. investigated the increased cost stemming studies where contamination of instruments and trocars
from practicing these precautionary measures, which is with cancer cells was much higher than contamination of
ultimately passed on to the patients . The authors stated carbon dioxide. Therefore, the measures recommended by
[56]
[66]
that all these precautionary measures may not be essential Tsivian and Sidi for the prevention of port site recurrence
because most of the breast reconstruction surgeries target in urologic surgery may be applied to all laparoscopic
low-stage tumor and there is no convincing evidence surgery and are listed below:
that breast cancer cells can successfully circulate, seed or (1) Sufficient technical preparation
implant in other anatomical areas. Based on a conservative (2) Avoidance of laparoscopic surgery if ascites is present
estimate, the patient is expected to bear a “precaution fee” (3) Trocar fixation with avoidance of gas leakage along the
amounting to $1231.83 per surgery. trocar
(4) Avoidance of tumor boundary violation
4.10. Prevention of implantation (5) Cautious consideration of morcellation
Can the implantation of cancer cells be prevented? Is (6) Use of an impermeable bag if morcellation is done
mechanical washing using saline sufficient or is a cytotoxic/ (7) Use of a bag for intact specimen removal
cytostatic agent needed? Among the multitude of chemicals (8) Drainage placement, if needed, before abdomen
tested on animal models were sodium hypochlorite, nitrogen deflation
mustard, ethyl alcohol, 5% formaldehyde, thiotepa, etc. [5,21- (9) Povidone-iodine irrigation of the laparoscopic
23] . Most authors found nitrogen mustard and formaldehyde instruments, trocar, and port site wounds
to be effective. Nash et al. found proflavine hemisulfate (10) Suturing of 10-mm trocar wounds
[57]
to be effective while topical oxaliplatin was also found to A retrospective study on 446 patients undergoing
[67]
prevent port site metastasis . More modern approaches cytoreduction for ovarian cancer, among which port
[58]
[59]
entail the introduction of drug-loaded hydrogels and site excision had been performed to prevent port site
dehydrated ethanol into the surgical cavity, which have recurrence in 82 patients, found no difference in survival
[60]
been proven to successfully prevent implantation of cancer between those with port site excision and those without.
cells. Electron therapy, if done within 10 – 15 days of A higher incidence of wound complications was seen in
thoracoscopy, has been found to be effective in impeding the excision group. The authors suggested that no port site
the implantation of cancer cells in patients with malignant resection be done in patients without microscopic evidence
mesothelioma after invasive thoracoscopy . of port site recurrence.
[61]
Ito et al. investigated the tumoricidal effects of hypo-
[62]
osmolar distilled water in vitro and in mice in vivo. The 5. Conclusions
in vitro assay showed tumor cell lysis in 15 min and a Despite the evidence of cancer cells implantation from
significant decrease in intraperitoneal tumor volume in the contaminated surgical sutures and knives, successful

Volume 2 Issue 3 (2023) 7 https://doi.org/10.36922/td.1411