Port Site Squamous Cell Carcinoma Following Video Endoscopic Inguinal Lymphadenectomy

Abstract

Port site metastasis is one of the feared complications following laparoscopic oncosurgery. We present the case report of port site recurrence following video endoscopic inguinal lymphadenectomy (VEIL) for carcinoma penis. A 54-year-old gentleman had undergone total penectomy with bilateral videoendoscopic inguinal lymphadenectomy 2 years back. Histopathology was reported as well-differentiated squamous cell carcinoma. Fifteen nodes on the right side and 8 nodes in the left were found negative for tumour. Ten months later, he presented with an indurated swelling in right mid-thigh with serous discharge at the site of camera and extraction port of VEIL. Core needle biopsy was done and reported as moderately differentiated squamous cell carcinoma. PET CT was done, and no other sites of activity were seen. Hence, wide local excision of the lesion with local rotation flap cover was done. Right iliac lymphadenectomy was done. The histopathology confirmed negative margins. Twelve iliac lymph nodes were negative for tumour. He received 3 cycles of cisplatin-based chemotherapy. This is the first case report of port site recurrence of squamous cell carcinoma following VEIL. The probable mechanisms are pneumatic spread or spill during extraction. The possibility of second primary should also be considered, due to negative lymph nodes in first biopsy. Port site recurrence is a rare but definite possibility following VEIL. Precautions should be taken like preventing air leak, using extraction bag and avoiding trocar slip to decrease the incidence of port site recurrence.