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- 저자 : Ming-Chen Ba (검색결과 1 건)
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Ming-Chen Ba,Hui Long,Xiang-Liang Zhang,Yuan-Feng Gong,Zhao-Fei Yan,Shuai Wang,Yun-Qiang Tang,Shu-Zhong Cui 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.3
Purpose: CO2 leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasisafter laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis betweenB-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 diseasetype, 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.
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