Port site resection after laparoscopy in advance ovarian cancer surgery: Time to abandon?

Abstract

IntroductionThe use of laparoscopy in the treatment and management of advanced ovarian cancer is increasing among the gynaecologic oncologists. The development of port site metastases after laparoscopy is a concern and a matter of debate due to theoretical iatrogenic disease spread. Port site resection (PSR) has been proposed as an option to avoid this scenario. Material and methodsOne hundred and twenty-three patients with advanced ovarian cancer (FIGO III-IV) and with diagnostic laparoscopy were included and after cytoreductive surgery were classified into two groups: no port site resection (No-PSR) and port site resection (PSR). Based on the pathological results of all port site specimens, PSR was classified as positive port site metastasis (PSM+) and negative port site metastasis (PSM-). ResultsIn 82 cases, the laparoscopic port site access was resected in the debulking surgery. At the final specimen examination, 49% presented as PSM+. No statistical differences regarding survival were found, either between the No-PSR and PSR groups (p = 0.28) or between the PSM+ and PSM - groups (p = 0.92). A higher wound complication rate was found in the PSR group (17% vs. 34%; p = 0.047). The RR (Relative Risk) of wound events for PSR was 2.42 (95% CI 1.09–5.35; p = 0.0296). ConclusionsTo date, not only there is no data supporting PSR after laparoscopy in advanced ovarian cancer, but the role of PSM+ in prognosis also remains unclear. In patients in which laparoscopy is performed prior to the debulking procedure, the PSR may not be recommended in those cases of no macroscopic port site metastasis.