ABSTRACT
We report a case of port-site metastasis after laparoscopic surgery for early stage uterine carcinosarcoma (UCS) and review the related literature. A 53-year-old woman with suspected uterine malignance underwent a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, infra-colic omentectomy, and pelvic lymphadenectomy resulting pathologically in a stage IA UCS. Twelve months later she developed a palpable abdominal-wall mass at the trocar site without other synchronous metastases. A mass resection was performed and it was pathologically diagnosed with port-site metastasis of UCS. When performing surgery for UCS, specimens should be carefully removed in case small pieces of the occult disseminated metastatic tissues are trapped between the outer surface of the trocar sleeve and the abdominal wall incisional canal. Despite the low incidence, a laparotomy might be considered rather than laparoscopy to prevent port-site metastasis and more gynecological oncology clinical practices might be relevant to the management of port-site metastasis.
Subject(s)
Female , Humans , Middle Aged , Abdominal Wall , Carcinosarcoma , Hysterectomy , Incidence , Laparoscopy , Laparotomy , Lymph Node Excision , Neoplasm Metastasis , Surgical InstrumentsABSTRACT
PURPOSE: CO₂ leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-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 disease type, 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.
Subject(s)
Humans , Ascites , Colorectal Neoplasms , Drug Therapy , Incidence , Karnofsky Performance Status , Laparoscopy , Neoplasm Metastasis , Ovarian Neoplasms , Perfusion , Surgical Instruments , Treatment OutcomeABSTRACT
Port-site metastases in gynecological malignancies subsequent to laparoscopy have been reported with an incidence of 1.1-16%. These metastases tend to be disappearing after primary debulking surgery and subsequent primary chemotherapy. Local resection, chemotherapy and/or radiotherapy have been defined in the management of these metastases with enhanced clinical success. However, in extremely rare cases these metastases were also defined very early during neoadjuvant chemotherapy. Herein, we present two ovarian cancer cases which are clinically diagnosed with port site metastasis during neoadjuvant chemotherapy following diagnostic laparoscopy. Although neoadjuvant chemotherapy is sometimes needed in cases of fully advanced ovarian cancers, port-site metastasis may be encountered during neoadjuvant chemotherapy. The possible poor prognosis of these patients, especially those who have ascites, should make us careful in performing diagnostic laparoscopy with preventive measures for port-site metastasis and to start the chemotherapy immediately.
Subject(s)
Humans , Ascites , Incidence , Laparoscopy , Neoplasm Metastasis , Ovarian Neoplasms , PrognosisABSTRACT
Herein, a rare case of port site metastasis, following a laparoscopic radical nephrectomy in a 62-years old male patient with a stage pT2N0M0 and Fuhrman grade III renal cell carcinoma, is reported. The patient suffered port site metastasis, with local recurrence. The port site metastasis was incidentally found in the patient during the laparoscopic examination for a laparoscopic mass resection of a local recurrent tumor. The most important appropriate surgical techniques are those where the port site metastasis can be controlled.
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Renal Cell , Laparoscopy , Neoplasm Metastasis , Nephrectomy , RecurrenceABSTRACT
Laparoscopic cholecystectomy (LC) is considered as the gold standard operation for the removal of a nonmalignant, diseased gallbladder. With the increasing number of LCs, a number of gallbladder carcinomas have been unexpectedly found either during or following this procedure. The removal of unexpected gallbladder carcinomas by LC can cause also a new complication, port site metastasis (PSM), which is developed by the implantation of tumor cells into the abdominal wall at the port site. We report a rare case of PSM of gallbladder carcinoma which was unsuspected at the time of LC. A 65-year-old man underwent LC at another hospital for calculous cholecystitis. The histologic examination revealed an adenocarcinoma of the gallbladder infiltrating the muscle wall. Despite the surgeon's advice, the patient refused any additional treatment. Ten months after surgery, he visited our hospital because of a painful and palpable subcutaneous mass at the scar of the periumbilical trocar incision. The mass was biopsed and histological examination confirmed metastasis from the gallbladder carcinoma.
Subject(s)
Aged , Humans , Abdominal Wall , Adenocarcinoma , Cholecystectomy, Laparoscopic , Cholecystitis , Cicatrix , Gallbladder , Neoplasm Metastasis , Surgical InstrumentsABSTRACT
The application of laparoscopy for the resection of a malignancy has been a question for debate among many active surgeons. Cases of unapparent GB cancer especially, following a laparoscopic cholecystectomy, can occasionally be diagnosed. We add another case, which occurred in a 60- year-old male, at 22 and 45 months following a laparoscopic cholecystectomy for gallstone, where there had been no evidence of a malignancy from a previous examination. The patient's metastatic port-site nodules were excised widely, and the patient is still alive.
Subject(s)
Humans , Male , Cholecystectomy, Laparoscopic , Gallstones , Laparoscopy , Neoplasm MetastasisABSTRACT
Objective To investigate effects of CO_2 pneumoperitoneum,helium pneumoperitoneum,and laparotomy on(port-)site and visceral metastasis in BALB/c nude mice bearing human colon cancer xenografts.Methods A nude mouse model with human colon cancer LoVo cell line xenografts was used.The mice were randomly divided into four groups: CO_2 Pneumoperitoneum Group,Helium Pneumoperitoneum Group,Open Surgery Group,and Control Group.A biopsy was performed in the former 3 groups,and the Control Group received no surgical intervention. Results All the mice were sacrificed for pathological examinations.Orthotopic tumor xenograft was successfully established in all the mice of the four groups(100%,86/86).The rates of port-site metastasis were 9.5%(2/21) in the CO_2 Pneumoperitoneum Group,9.1%(2/22) in the Helium Pneumoperitoneum Group,and 19.0%(4/21) in the Open Surgery Group,respectively,without significant differences among the three groups(?~2=1.227,P=0.541).The rates of liver metastasis were 38.1%(8/21) in the CO_2 Pneumoperitoneum Group,31.8%(7/22) in the Helium Pneumoperitoneum Group,52.4%(11/21) in the Open Surgery Group,and 31.8%(7/22) in the Control Group,respectively,without significant differences among the four groups(?~2=2.543,P=0.468).Conclusions As compared with laparotomy and control groups,artificial pneumoperitoneum doesn't cause an increase of rates of port-site and visceral metastasis.Moreover,there is no significant difference between CO_2 pneumoperitoneum and helium pneumoperitoneum in rates of port-site and visceral metastasis.