Laparoscopic technique was quickly adopted in general surgery because of less pain, quicker recovery and shorter hospital stay. In the 1990´s several reports on port site metastases restrained the enthusiasm to use laparoscopic surgery in malignant diseases. The numerous reports on port site metastases initiated a debate whether laparoscopic surgery would increase the risk of tumour spread and growth. Personal experience of two patients who devloped port site metastases from an incidental gall bladder cancer (GBC) after laparoscopic cholecystectomy (LC), encouraged us to study the incidence of wound metastases from GBC after laparoscopic and open cholecystectomy (OC). Experimentally we examined whether pneumoperitoneum would increase the risk of tumour development. Several studies had demonstrated that minimally invasive procedures exert a less negative influence on the immune system and may have beneficial effects for cancer patients. We wanted to compare the long term survival after OC and LC and if the occurence of port site metastases had any impact on survival…
Contents
INTRODUCTION
History of laparoscopic surgery
Carcinoma of the gallbladder
The concept and aetiology of port site metastases
Definition
Clinical situation
Incidence
Aetiology
Haematogenous spread
Wound implantation
Surgical technique
Pneumoperitoneum
Immune response
AIMS
PATIENTS, MATERIALS AND METHODS
Clinical studies – paper I, II and III
Statistics and ethics
Experimental studies – paper IV, V and VI
Laser Doppler blood flow
Statistics and ethics
RESULTS
Clinical studies – paper I, II and III
Experimental studies – paper IV, V and VI
DISCUSSION
Clinical studies – paper I, II and III
Experimental studies – paper IV, V and VI
SUMMARY AND CONCLUSIONS
ACKNOWLEDGEMENTS
REFERENCES
PAPERS I-VI
Author: Lundberg, Owe
Source: Umea University
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