AccScience Publishing / TD / Volume 2 / Issue 3 / DOI: 10.36922/td.1411
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REVIEW

Surgical implantation of malignant cells: A review of evidence from 1850 to present day

Ajay Vidyarthi1* ,  Kunal Ranjan1 ,  Pritesh Rajeev Singh1 ,  Shruti Khemka1 ,  Vinay Venkataramu1
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1 Department of Head and Neck Oncology, Mahavir Cancer Sansthan and Research Centre, Patna, Bihar, India
Tumor Discovery 2023, 2(3), 1411 https://doi.org/10.36922/td.1411
Submitted: 28 July 2023 | Accepted: 13 November 2023 | Published: 30 November 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Malignant cells, due to decreased cohesion between them, are more likely to exfoliate and implant at distant sites during manipulation. This concern was first expressed by A.G. Gerster in 1885. In this review, we undertook a comprehensive search of the literature to find the evidence for or against the iatrogenic implantation of cancer cells. An exhaustive search on PubMed, Medline, Embase, Science Direct, and Google Scholar yielded 215 relevant publications. The evidence presented in these publications was extracted and synthesized to draw conclusions for this review. Diagnostic and therapeutic procedures through fine/wide bore needles have demonstrated malignant cells in the needle tract but the incidence of recurrences ranges from 0.0003% to 0.9%. There is evidence of malignant cells adhering to surgical instruments, and some reports showed that the number cells needed for successful implantation is 106 – 107 cells in porcine models. A recent prospective study on colorectal malignancies has shown that the presence of intraperitoneal cells reduced 2-year survival but was not an independent predictor of the outcome. Port site recurrences have been documented since 1978 but the current consensus is more inclined to supporting the improper manipulation of tumor, rather than the laparoscopic procedure itself, as the inducer of port site recurrences. Intraperitoneal morcellation of leiomyomas and leiomyosarcomas does cause intra-peritoneal dissemination of tumor cells. Finally, many approaches to preventing implantation have been explored but lavage of operative site with distilled water may stand as the most promising strategy.

Keywords
Iatrogenic implantation
Malignant cells
Fine needle aspiration
Port site recurrence
Morcellation
Perception and practices
Funding
None.
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Conflict of interest
The authors declare that they have no conflict of interest to declare.
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Tumor Discovery, Electronic ISSN: 2810-9775 Published by AccScience Publishing
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