Address of Corresponding Author

Tumor Biol 2005;26:94-102 (DOI: 10.1159/000085816)

  Key Words

• Cancer
• Laparoscopy
• Pneumoperitoneum
• Metastasis
• Invasion

  Abstract

Objective: The use of laparoscopic techniques in resection of malignant tumours has been proposed to offer potential benefit to the patient in the form of earlier recovery and less immune paresis; however, reported tumour seeding, both peritoneal and at port site, has put this approach into question. The biological effects of the introduction of carbon dioxide or helium to form a pneumoperitoneum on tumour invasion and dissemination are unknown. Methods: A human colonic adenocarcinoma cell line (SW1222) was exposed to in vitro laparoscopic environment of either carbon dioxide or helium for 4 h, mimicking the duration of a laparoscopic colorectal resection. Alteration in production of matrix metalloproteinase (MMP)-2, MMP-9 and urokinase-type plasminogen activator (uPA) due to exposure to a laparoscopic environment was determined by zymogra phy and correlated to invasive capacity by a standard Matrigel-based invasion assay. Incorporation of specific gelatinase inhibitors or antibodies directed at the uPA receptor was utilized to determine the relative importance of proteases. Results: Exposure to the laparoscopic environment significantly enhanced production of the proteases MMP-2, MMP-9 and uPA. A concomitant enhancement of invasive capacity was also observed, being blocked by specific protease inhibitors. Changes in both protease production and aggression were observable for at least 24 h following the removal of the operative environment, indicating the possible long-term effects of the initial insult. Conclusion: Exposure to the laparoscopic environment enhances the invasive capacity of colonic adenocarcinomas via a well-defined protease-determined pathway. It therefore appears likely that tumour cells released into the operative field can be made increasingly aggressive by a laparoscopic operative environment and can thus contribute to disease dissemination.

Copyright © 2005 S. Karger AG, Basel

  Author Contacts

Dr. D. Peck
Academic Surgical Unit, 10^th Floor QEQM wing
St. Mary's Hospital, London W2 1NY (UK)
Tel. +44 207 886 6175, Fax +44 207 886 1810
E-Mail p.paraskevas@ic.ac.uk

  Article Information

Received: September 5, 2004
Accepted after revision: January 6, 2005
Published online: May 13, 2005
Number of Print Pages : 9
Number of Figures : 6, Number of Tables : 1, Number of References : 33