Port-Site Metastasis Following Laparoscopic Surgery

Abstract

In the 1990s, laparoscopic surgery became accepted as a standard approach for general surgical operations including cholecystectomy (Barkun et al., 1992) and appendectomy (Attwood, Hill, Murphy, Thornton, & Stephens, 1992). In these randomized studies, the laparoscopic compared to the open approach resulted in decreased length of hospital stay, fewer postoperative complications, more rapid return to normal activities with reduced analgesic requirements. This was associated with decreased cost of care and also achieved superior cosmetic results leading to increased patient satisfaction. Following this, the frontier of laparoscopic surgery was pushed further forward through experimentation of other complex intraabdominal surgery including colorectal surgery (Milsom, Lavery, Church, Stolfi, & Fazio, 1994), bariatric surgery (Cowan, 1992) and more recently hepatopancreaticobiliary surgery (Gigot et al., 2002). The growth and expanded role of laparoscopic surgery in abdominal operations meant that cancer surgery may now be performed using laparoscopy. Despite the perioperative advantages, laparoscopic cancer surgery has been highly debated and its oncological appropriateness has been questioned. Doubts over the technique concerned compromising oncologic principles through loss of the surgeon’s ability to perform tactile assessment which could otherwise have been performed in an open surgery. It was also thought that with laparoscopic approach may limit the extent of resections. For example, in the setting of laparoscopic colon resection, reduced lymph nodes harvested from insufficient mesentery may make disease staging inaccurate. Further, there are concerns regarding the development of port-site metastasis. Port site metastasis was first described by Dobronte and colleagues (Dobronte, Wittmann, & Karacsony, 1978) who described the case of a patient developing local tumor metastases in the abdominal wall two weeks after laparoscopy for malignancy and explained that this occurred due to infiltration of malignant ascites during needle and trocar insertion into the abdominal cavity at the port site. Since this report, there has been extensive publication of case reports in the literature, describing this phenomenon in gastrointestinal (Cook & Dehn, 1996), urological (Chueh, Tsai, & Lai, 2004) and gynaecological malignancies (Sanjuan et al.,