Cervical cancer metastasis on the surgical wound: not a new feature and not specific to laparoscopy. Report of two cases and review of the literature

Abstract

Objective The appearance of cervical cancer metastases on the abdominal wall is unusual and almost always indicates an extremely poor prognosis. More specifically however, metastases on the surgical wound or trocar insertion site are extremely rare while their pathophysiology and clinical significance remain controversial. This study presents two cases and attempts to clarify the pathophysiology and suggest clinical strategies. A literature review is also presented. Setting Department of Gynecology, Ioannina University Hospital, Ioannina, Greece. Subjects Two cases of patients presenting with cervical cancer who developed metastasis on the surgical wound or a laparoscopy trocar insertion site are described. Results Apart from the two cases encountered by the authors, nine more have been reported. Five out of the total of 11 cases had metastasis on a laparoscopy trocar insertion site and the rest on the surgical wound. Nine out of the 11 women had been treated at an early stage (IB). In five patients the metastasis on the wound or the trocar site was the only one at the time of the diagnosis. A marked delay in the diagnosis of metastasis was noted in many cases. Conclusions Possible mechanisms for development of metastasis on the wound or the trocar site are analysed. Metastasis on the surgical wound is not always associated with laparoscopy. Careful haemostasis, avoidance of haematoma formation, careful handling of tissues especially in laparoscopy and the extension of radiotherapy fields to include the wound or trocar sites might prevent the development of metastasis. Alertness on the part of surgeons is advised, in order to ensure immediate diagnosis and wide excision of these metastases, as they are often the only site of relapse.