Case Of Port-site Metastasis Research Articles

Pathologically Confirmed Port Site Metastasis After Laparoscopic Radical Prostatectomy: Case Report and Literature Review

Laparoscopic port site metastases remain exceedingly rare for urologic tumors, despite the increasingly widespread use of laparoscopic techniques in the management of urologic malignancy. We report a case of port site metastases after transperitoneal laparoscopic radical prostatectomy.

Port Site Metastasis of B-cell Lymphoma

Minimally invasive techniques have been accepted as safe and reliable in the work-up of patients with lymphoproliferative disorders. As the oncologic indications of laparoscopy expand, many authors have raised concerns regarding the occurrence of port site metastases after minimally invasive procedures for a multiform array of neoplastic diseases. A review of the existing literature demonstrates no mention of port site occurrence following staging laparoscopy for malignant hematologic disorders. We report the first case of port site metastasis after diagnostic laparoscopy in a patient with large B-cell lymphoma. As these procedures become more common, we may be exposed to the increasing numbers of patients with this clinical presentation. A clear knowledge of the technical steps to minimize risk of port site metastasis is mandatory for any advanced laparoscopic surgeon.

Port-site and liver metastases after laparoscopic pelvic and para-aortic lymph node dissection for surgical staging of locally advanced cervical cancer

Recently, we experienced a case of port-site and liver metastases after 75 cases of laparoscopic transperitoneal pelvic lymph node dissection (PLND) and para-aortic lymph node dissection (PALND) for surgical staging of locally advanced cervical cancer. A 45-year-old-woman with stage IIB cervical adenocarcinoma underwent laparoscopic PLND and PALND for surgical staging. There was no intraperitoneal disease and cervical tumor was not manipulated at the time of laparoscopic surgery. Pathologic examination revealed only one micrometastasis in left internal iliac lymph node (LN), measuring 1 mm, of the 60 pelvic and para-aortic LNs removed. She received concurrent chemoradiation therapy and pelvic mass disappeared completely. One month after the completion of therapy, both lateral and umbilical port-site and liver metastases were detected. We conclude that although cases of port-site metastasis have mostly occurred after extensive disease, the possibility of such complication should be kept in mind at laparoscopy of early cancer and laparoscopy which does not manipulate primary tumor.

Incidentally Found Port Site Metastasis followings Laparoscopic Radical Nephrectomy for a Renal Cell Carcinoma

Tae Hwan Kim, Seung Hyun Jeon, Hyung-Lae Lee From the Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea Herein, a rare case of port site metastasis, following a laparoscopic radical nephrectomy in a 62-years old male patient with a stage pT2N0M0 and Fuhrman grade III renal cell carcinoma, is reported. The patient suffered port site metastasis, with local recurrence. The port site metastasis was incidentally found in the patient during the laparoscopic examination for a laparoscopic mass resection of a local recurrent tumor. The most important appropriate surgical techniques are those where the port site metastasis can be controlled. (Korean J Urol 2007;48:870-873) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Port site metastasis of renal cell carcinoma after laparoscopic transperitoneal radical nephrectomy

Laparoscopic radical nephrectomy is a safe and oncologically appropriate treatment modality for patients with renal cell carcinoma.[1] Till date, there are only 3 cases of port site metastasis reported after laparoscopic radical nephrectomy for renal cell carcinoma. We herein report another case of port site recurrence after transperitoneal radical nephrectomy for a 5 cm renal tumor.

Port site metastases after robot-assisted laparoscopic radical cystectomy

Laparoscopy has become a well-established alternative to open surgery for the management of many urologic tumors. Metastases at one of the port sites is not a common complication, though there are some reports of port site metastases after laparoscopic management for renal tumors and pelvicaliceal tumors, as well as after laparoscopic lymphadenectomy. Herein, we report a case of port site metastases after robot-assisted laparoscopic radical cystectomy for muscle-invasive bladder cancer. To the best of our knowledge this is the first case of such pathology to be reported. Although rare, the laparoscopic surgeon should be aware of such complications when dealing with malignant masses.

Métastase orificielle après prostatectomie radicale cœlioscopique pour un adénocarcinome mucineux de la prostate

A 52-year-old man underwent laparoscopic radical prostatectomy for mucinous adenocarcinoma. Eight months later, an abdominal wall metastasis developed at the trocar site through which the laparoscope had been introduced. To our knowledge, it is the first reported case of port site metastasis after laparoscopic radical prostatectomy.

Abdominal Wall Metastasis After Retroperitoneoscopic Assisted Total Nephroureterectomy for Renal Pelvic Cancer

We report a rare case of port site metastasis following retroperitoneoscopic assisted total nephroureterectomy for renal pelvic cancer. This metastasis developed despite the fact that the organ had been removed intact. CASE REPORT A 68-year-old man presented with asymptomatic gross hematuria. Voided urine cytology revealed malignancy. Abdominal computerized tomography (CT) and ultrasonography demonstrated right renal pelvic tumor without apparent metastasis (parts a and b of figure). Retroperitoneoscopic assisted right total nephroureterectomy was elected, consisting of retroperitoneoscopic radical nephrectomy performed via 3 trocars, followed by open distal ureterectomy with excision of the bladder cuff. The specimen was removed intact from the lower pararectal incision used for distal ureterectomy, and the operation was completed uneventfully. Although the tumor was completely removed, because the pathological diagnosis was pT3N0M0 squamous cell carcinoma (SCC) directly invading the renal parenchyma, 2 courses of adjuvant methotrexate, etoposide and cisplatin were administered. Six months postoperatively the patient was symptom-free. However, on physical examination a hard induration was palpable at one of the trocar sites, and serum SCC antigen had increased to 7.6 ng/ml. CT showed an irregularly enhancing mass in the muscle layer into which a trocar had been inserted (part c of figure). Percutaneous needle biopsy revealed abdominal wall metastasis of SCC. Because there was no other metastasis, radical tumor resection with a sufficient surgical margin including partial ostectomy of the iliac crest was performed, followed by repair of the aponeurotic defect with synthetic mesh. Pathological diagnosis was well differentiated SCC originating from the trocar site. Postoperatively, serum SCC antigen level immediately returned to normal. The patient has been disease and symptom-free for 6 months. DISCUSSION

Feasibility and Safety of Total Laparoscopic Radical Hysterectomy

Study Objective To evaluate feasibility and morbidity of a total laparoscopic radical hysterectomy (TLRH). Design Retrospective chart review (Canadian Task Force classification II-3). Setting Gynecologic cancer center. Patients Fifty-five women with cervical (39), endometrial (8), vaginal (2), or recurrent colon cancer (1), or severe pelvic endometriosis (5) followed for 3 years. Intervention TLRH in 55 women, converted to laparotomy in 3 (5.5%). Measurements and Main Results Feasibility, safety, patterns of recurrence, and survival were assessed. Estimated blood loss was 200 ml (range 50–2000 ml), median total operating time was 210 minutes, and median hospital stay was 5 days. Intraoperative complications were three vascular injuries and one obturator nerve palsy, all of which occurred in the first half of the series. Early postoperative morbidity included deep vein thrombosis, pulmonary embolism, bladder infection and dysfunction, and vaginal fistula. These events occurred less frequently in the second half of the series. Late postoperative morbidity consisted of lymphedema, pelvic abscess and lymphocyst formation, pelvic cellulitis, hyperesthesia of the leg, and small bowel obstruction. The only fatality was a patient who developed a pulmonary embolus on postoperative day 3. Median follow-up was 36.5 months. Of 39 women with cervical cancer, 34 were alive and disease free at their last visit. No case of port site metastasis occurred during follow-up. Conclusion TLRH carries acceptably low morbidity that can be reduced with experience with the technique.

Port site recurrences after laparoscopic cholecystectomy.

Port site metastasis is a well-documented event after laparoscopic procedures in cancer patients. We summarize current epidemiological knowledge about the risk of this complication after laparoscopic/conventional cholecystectomy in patients with unexpected gallbladder cancer as well as other intraabdominal malignancies. We found 174 cases of port site metastasis after laparoscopic cholecystectomy and 12 recurrences in the surgical scar after converted or open cholecystectomy. A review of all case reports and its comparison with four international surveys show a 14% incidence of port site metastases 7 months after laparoscopic cholecystectomy for cancer. Similar numbers are available for open cholecystectomy. Our data suggest that abdominal wall metastases of gallbladder cancer are not a specific complication of laparoscopy. The long-term prognosis of patients with unknown gallbladder cancer however seems to be worsened by laparoscopy. The registry of the German Society of Surgery, which prospectively compares follow-up and prognosis of all cases of cholecystectomy, laparoscopic as well as open, in patients with incidental gallbladder cancer will definitively clarify whether laparoscopy affects the prognosis of patients with unsuspected gallbladder cancer.

Laparoscopic Port-Site Recurrence Following Surgery for a Stage IB Squamous Cell Carcinoma of the Cervix with Negative Lymph Nodes

Background. Port-site metastases are commonly reported after laparoscopic surgery for ovarian cancer, but have also been reported in patients with cervical or endometrial cancer with positive lymph nodes. Recently, a case of port-site recurrence after laparoscopic surgery for a patient with node-negative early-stage adenocarcinoma of the cervix was reported. We report the first case of port-site metastasis in a patient with stage IB squamous cell carcinoma of the cervix with negative lymph nodes.Case. A 31-year-old woman had a laparoscopy for pelvic pain. Under anesthesia, she was noted to have a grossly abnormal-looking cervix and a biopsy revealed squamous cell carcinoma. She was referred to a gynecological oncologist and underwent radical hysterectomy and pelvic lymph node dissection through a transverse lower abdominal incision 6 weeks later. Nineteen months postoperatively, she presented with a soft tissue mass in a suprapubic laparoscopic trocar site.Conclusion. It is postulated that cells dislodged at the time of cervical manipulation and biopsy may have passed through the fallopian tubes and implanted in the laparoscopic port site due to the “chimney effect” caused by the pneumoperitoneum.

Laparoscopic Port-Site Metastasis of an Early Stage Adenocarcinoma of the Cervix With Negative Lymph Nodes

Background. Port-site metastasis (PSM) following laparoscopic surgery for cancer is being increasingly recognized as a potential problem; the majority of cases appear following laparoscopy for a pelvic mass that subsequently proved to be malignant or in the case of a disseminated intraperitoneal disease. The rare cases of PSM following laparoscopy for endometrial and cervical cancer have all been associated with the presence of regional lymph node metastasis or disseminated disease in the peritoneal cavity. We present here a case report of PSM in the absence of spread beyond the primary tumor.Case. A 48-year-old woman with stage IA1 adenocarcinoma of the cervix was treated with laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic node dissection. The pathologic study revealed an endocervical adenocarcinoma confined to the cervix with negative lymph nodes. Nine months postoperatively, a cutaneous metastasis at the port-site was diagnosed. This was treated with wide local excision of the recurrence and the port-site track. Explorative laparotomy and para-aortic node sampling showed no evidence of recurrence elsewhere.Conclusion. This case emphasizes the risk for PSM in laparoscopic surgery performed for early stage disease.

PORT SITE METASTASIS AFTER LAPAROSCOPIC NEPHRECTOMY: UNSUSPECTED TRANSITIONAL CELL CARCINOMA WITHIN A TUBERCULOUS ATROPHIC KIDNEY

The risk of tumor implantation after percutaneous resection of transitional cell carcinoma is well known. To our knowledge, however, only 1 case of port site metastasis after laparoscopic nephroureterectomy has been reported. We report a case of port site metastasis after laparoscopic nephrectomy of unsuspected transitional cell carcinoma within a tuberculous atrophic kidney. CASE REPORT

Port site metastasis from synchronous primaries of the colon and ovary following laparoscopic cholecystectomy

We report two cases of port site metastasis as the presenting feature of colonic and ovarian carcinoma after laparoscopic cholecystectomy. Cholecystectomy was performed for upper abdominal pain and gallstones. Six and 4 months after the operation the patients presented with nodules at port sites, other than the site of extraction. Biopsy proved both to be adenocarcinoma and further management found these to be from advanced caecal and ovarian carcinomas.

Port Site Recurrences after Laparoscopic Surgery

Port site metastasis has been a surprising event after laparoscopic procedures in cancer patients. No clear data exist about this phenomenon. The aim of this study is to summarize current epidemiologic knowledge about the risk of this complication. A review of all case reports about port site recurrences was undertaken. To date, 164 cases of port site metastases after videoscopic procedures have been reported in 90 papers. We found 108 cases of implantation after laparoscopy for digestive tumors, 23 after thoracoscopy, 29 after gynecological and 4 after urological laparoscopy. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization to the trocars and instruments. Also low-staged and highly differentiated tumors have been reported to cause post-laparoscopy tumor seeding. The temporary data of the CAE registry ‘port site metastases’ (Workgroup for Surgical Endoscopy of the German Society of Surgery) are also reported. The analysis of 80 histologically confirmed cases of port site recurrence shows a particular frequency after laparoscopic cholecystectomy for unsuspected gallbladder cancer (n = 59). Postoperative specimen examination revealed a T1 carcinoma in 9 cases (15%), T2 carcinoma in 33 (21%), T3 in 3 (5%) and T4 in 1 case (1.7%). The mean time to clinical tumor relapse was 6 months. Similar patterns were found in a lower number of port site metastases after laparoscopy for colon cancer (n = 2) and for other cancers (n = 9).Clinical evidence that laparoscopy with CO₂ pneumoperitoneum can enhance tumor dissemination is given. Port site metastases seem to be secondary to multiple factors including the gas used, local trauma, tumor manipulation, biologic properties of the tumor, and individual surgical skills.