Metastatic Renal Cell Carcinoma within a Previous Port-Site following Retroperitoneoscopic Radical Nephrectomy

Abstract

Introduction: Laparoscopic radical nephrectomy is an ac-cepted treatment option for localized renal cell carcinoma (RCC) in appropriately selected patients. There have been 6 previous reports of locoregional port-site tumor metastasis following laparoscopic radical nephrectomy. We present a case of RCC metastasis occurring in the lumbar musculature within a previous trocar site 11 months after retroperitoneo-scopic radical nephrectomy. Methods: A 78-year-old Caucasian male underwent an uncomplicated right retroperito-neoscopic radical nephrectomy for a 6.5-cm right renal mass (stage pT1bN0M0). Eleven months postoperatively, he was found to have metastatic disease with recurrence in the liver and within the lumbar musculature at a previous port site. A biopsy of this lesion was performed and confirmed meta-static RCC. We performed a comprehensive Medline search for all published studies of port-site recurrences following laparoscopic radical nephrectomy for organ-confined RCC. Results: Six cases of port-site recurrence following successful laparoscopic radical nephrectomy for locally confined disease have been reported. The reported proposed etiologic factors for port-site recurrence include biologic aggressiveness of the tumor, patient immunosuppression, local wound factors, procedure and technique related factors. We report the seventh case of recurrent disease within a port-site following successful laparoscopic radical nephrectomy for organ-confined disease. Conclusion: Port-site tumor recurrence after laparoscopic radical nephrectomy for RCC is a rare occurrence. One of the factors that contribute to its oc-currence may be surgeon-related, and therefore, potentially preventable.