Abstract

Introduction: Port site metastases have been reported with laparoscopic surgery. The mechanism of action is unknown. Theories include tumor tracking, spillage, pneumoperitoneum, and immune factors. Methods: We report on a case of aggressive port site metastases and intra-abdominal recurrence after an uncomplicated laparoscopic hysterectomy for a grade 2, minimally invasive endometrioid adenocarcinoma of the uterus. The world literature on port site metastases in gynecological cancer is reviewed. Results: Port site metastases have two distinct presentations. In the first pattern, the metastases are isolated to the laparoscopic port sites. In the second pattern, port site metastases are associated with widespread intra-abdominal recurrence. Conclusion: Port site metastases are rare but occur with laparoscopic surgery. Meticulous attention to surgical technique including the use of specimen bags to isolate tissue and prevent spillage should be performed. Data registries should be instituted to track the incidence and outcomes of port site metastases.

Highlights

  • IntroductionHow to cite this paper: Outaggarts, Z., Johnstone, S. and Goodman, A. (2015) Port-Site Metastasis after Laparoscopic Surgery with Rapid Second Recurrence in Early Stage Endometrial Carcinoma: A Case Report and Review of the Literature

  • Port site metastases have been reported with laparoscopic surgery

  • The main concern is whether port-site metastasis is iatrogenic or is driven by the tumor’s biology, in which the tumor just does not behave as the FIGO criteria would predict

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Summary

Introduction

How to cite this paper: Outaggarts, Z., Johnstone, S. and Goodman, A. (2015) Port-Site Metastasis after Laparoscopic Surgery with Rapid Second Recurrence in Early Stage Endometrial Carcinoma: A Case Report and Review of the Literature. (2015) Port-Site Metastasis after Laparoscopic Surgery with Rapid Second Recurrence in Early Stage Endometrial Carcinoma: A Case Report and Review of the Literature. In a large study with 1694 patients, who underwent laparoscopic surgeries for malignant gynecological cancers, 20 patients (1.18%) developed port-site metastases [2]. In another report of 295 patients who underwent laparoscopy for endometrial cancer, one patient developed PSM (0.33%) [3]. Only eight cases of port-site metastasis along with intra-abdominal recurrence after surgery for endometrial cancer have been reported in literature [4]. We describe a patient who developed a rapid recurrence of a minimally invasive, low to intermediate-grade endometrial cancer. The literature on PSM after laparoscopic surgery for malignancies and possible mechanisms of tumor spread in minimally invasive surgery are reviewed

Case Report
Discussion
Review of the Literature
Clinical Significance
Laparotomy vs Laparoscopy
Hypothesis of the Mechanism for Port Site Metastases
Preventive Measures
Findings
Possible Reasons Why Our Patient Developed Port Site Metastases
Conclusion
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