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[Effect of carbon dioxide pneumoperitoneum-laparoscopic surgery on tumor seeding and metastases in endometrial cancer].

OBJECTIVE
To explore the influence of carbon dioxide pneumoperitoneum-laparoscopic surgery on tumor cell seeding and metastases in endometrial cancer.


METHODS
Twenty patients with endometrial cancer who underwent laparoscopic surgery and 10 patients with endometrial cancer who underwent laparotomic surgery were enrolled. Each patient was in preoperative clinical StageIand the uterus size in each patient was less than 12 weeks of pregnancy. Carbon dioxide pneumoperitoneum was established and maintained with CO2 insufflation at 4 approximately 6 L/min and intraperitoneal pressure of 13 mmHg with an automatic pneumoperitoneum machine. Cytologic examination of peritoneal fluid(at the beginning and end of the operation), CO2 filtrated gas and the lavage fluid of instruments during the laparoscopic surgery were performed. The protein expressions of E-cadherin,beta-catenin,P-selectin,matrix metalloproteinase-2(MMP-2),vascular endothelial growth factor (VEGF),and CD44v6 in tumor tissues before and after the operation were detected by DAKO Envision.


RESULTS
There were no case of positive washing cytology in the peritoneal fluid,CO2 filtrated gas, and the lavage fluid of instruments during the laparoscopic surgery. The expressions of E-cadherin and beta-catenin proteins were obviously abnormal in endometrial cancer. The abnormal expressions of E-cadherin and beta-catenin protein between the pre- and post-operations were not significantly different in both the laparoscopic group and the laparotomic group(P>0.05).The changes of abnormal expressions of E-cadherin and beta-catenin protein were no statistical difference between the two groups(P>0.05). The positive protein expressions of P-selectin,MMP-2,VEGF,and CD44v6 were not significantly different between the pre- and post-operations both in the laparoscopic group and the laparotomic group(P>0.05),and there was also no significant difference between the laparoscopic group and the laparotomic group(P>0.05).The follow-up period in the laparoscopic group was 7 approximately 19 (14.25+/-3.65) months and 7 approximately 19 (13.10+/-4.23) months in the laparotomic group. One patient got infection in the urinary system in the laparoscopic group and one patient had lower extremity venous thrombosis in the laparoscopic group.No recurrence was detected in both groups.


CONCLUSION
Laparoscopic surgery for endometrial cancer has no effect on protein expressions of E-cadherin,beta-catenin,P-selectin,MMP-2,VEGF,and CD44v6 in tumor tissues. No evidence has been found that CO2 pneumoperitoneum-laparoscopic surgery may favor endometrial cancer cell seeding and metastases.