Incidence Of Port-site Metastases Research Articles

Propensity Score Analysis of Outcomes Following Laparoscopic or Open Radical Resection for Gallbladder Cancer in T2 and T3 Stages

BackgroundAlthough laparoscopic radical resection (LRR) has long been contraindicated in gallbladder cancer (GBC), recent studies have demonstrated laparoscopic surgery did not adversely affect the perioperative and survival outcomes of GBC patients. However, these literatures are mainly focused on GBC of relatively early stages or incidental GBC. This study aimed to investigate the perioperative and long-term outcomes of LRR versus open radical resection (ORR) for GBCs in T2 and T3 stages. MethodsA retrospective study was conducted on 99 patients with GBC of T2 and T3 stages who underwent radical resection at Zhejiang Provincial People’s Hospital from January 2010 to December 2020. A 1:1 propensity score matching (PSM), which is widely used to reduce selection bias, was performed to compare the surgical outcomes and long-term prognosis between LRR and ORR. A logistic regression analysis was implemented to identify the predictive risk factors of postoperative overall survival. ResultsBy using PSM, the baseline characteristics of two groups (with 30 patients in each group) were generally well balanced. In the LRR group, the length of operation was significantly longer than the ORR group, but the intraoperative bleeding and postoperative days of hospital stay were significantly decreased compared to the ORR group. The two groups showed comparable outcomes regarding the incidence of biliary reconstruction, lymph node yield, the incidence of postoperative morbidities, the incidence of Clavien–Dindo (C–D) grades III–IV, the days of drainage tubes indwelling, mortality at 30 postoperative days and 90 postoperative days, and the incidence of port-site metastasis. The 1-, 2-, and 3-year overall survival rates were 61.2, 40.1, and 30.1%, respectively, in the LRR group, and 53.3, 40.1, and 40.1%, respectively, in the OLR group (P = 0.644). On multivariate analysis, T stage, vascular invasion, and tumor differentiation were found to be the independent risk factors for overall survival of GBC in T2 and T3 stages. ConclusionsFor GBC in T2 and T3 stages, LRR can achieve comparable perioperative outcomes and similar long-term survival benefit compared to ORR. LRR tends to show advantages over ORR regarding intraoperative bleeding and postoperative days of hospital stay.

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Incidence of Port Site Metastasis in Laparoscopic Radical Nephroureterectomy: Single-institution Experience

ObjectiveTo address the incidence and potential risk factors of port site metastasis (PSM) in patients who underwent laparoscopic radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Materials and MethodsBetween January 2013 and December 2018 laparoscopic RNU were performed in 240 patients at our institution, including 145 with renal pelvic tumor and 135 with ureteral tumor (40 patients have both tumor). Laparoscopies were performed through the transperitoneal approach in 28 patients, and retroperitoneal in 212 patients. Clinical data are retrospectively collected. ResultsPerioperative and pathologic data are available in all 240 cases. After a mean follow-up of 12.6 months (range 3-45 months), 4 patients (1.7%) developed PSM following retroperitoneal RNU at an average of 4.3 months. Tumor stage is T2N0M0 in one, T3N0M0 in two, and T3N1M0 in one, respectively. Tumor grade are high-grade urothelial carcinoma in all. The incidence of PSM is 2.8% (4/145) and 0.7% (1/135) in renal pelvic and ureteral tumor, respectively. ConclusionWe report a 1.7% incidence of PSM in upper tract urothelial carcinoma after laparoscopic RNU. We suggest that air leakage during retroperitoneal approach, high tumor stage (pT3) and grade, and advanced renal pelvic tumor with micrometastases could increase the potential risks of PSM.

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. A systematic PubMed search of the English literature to May 2018 was conducted. The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.

Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy.

PurposeCO2 leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy (HIPPC).Materials and MethodsSixty-two patients with malignant ascites induced by gastrointestinal or ovarian cancer were divided into two groups to receive either B-ultrasound-guided or laparoscopically-assisted HIPPC. Clinical efficacy was assessed from the objective remission rate (ORR), the Karnofsky Performance Status (KPS) score, and overall survival. The incidence of port-site metastasis was compared between the two groups.ResultsPatients in the B-ultrasound (n=32) and laparoscopy (n=30) groups were comparable in terms of age, sex, primary disease type, volume of ascites, and free cancer cell (FCC)-positive ascites. After HIPPC, there were no significant differences between the B-ultrasound and laparoscopy groups in the KPS score change, ORR, and median survival time. The incidence of port-site metastasis after HIPPC was not significantly different between the B-ultrasound (3 of 32, 9.36%) and laparoscopy (3 of 30, 10%) groups, but significantly different among pancreatic, gastric, ovarian, and colorectal cancer (33.33, 15.79, 10.00, and 0.00%, p<0.001).ConclusionThe chimney effect may not be the key reason for port-site metastasis after laparoscopy. Other factors may play a role, including the local microenvironment at the trocar site and the delivery of viable FCCs (from the tumor or malignant ascites) to the trauma site during laparoscopic surgery.

Trocar metastases in laparoscopic approach for gynecologic malignancies. A short review of the literature.

Compared to laparotomy, laparoscopy has many benefits for patients, such as shorter recovery and lower morbidity rates. Port site metastases after laparoscopic approach in the treatment of gynecologic malignancies are uncommon. The purpose of this review is to identify and summarize possible risk factors for port-site metastases in patients undergoing laparoscopic surgery in the ambit of gynecologic oncology. The precise incidence of port-site metastases is not well known because many patients are not followed-up during the whole postoperative period. Possible risk factors that can increase the risk of port-site metastases can be the presence of large masses in the abdomen, especially in the presence of concomitant ascites and in patients treated for ovarian carcinomas. Different theories have been postulated in order to explain the development of port site metastases during laparoscopy for oncological patients. Patient selection is an essential factor that can influence the incidence of port site metastases in gynecological patients. Robust data regarding port site metastases in gynecologic oncology are needed.

The role of laparoscopy in staging of different gynaecological cancers

Apart from cervical and vaginal cancers that are staged by clinical examination, most gynaecological cancers are staged surgically. Not only can pelvic and para-aortic lymphadenectomy offer accurate staging information that helps determine patients' prognosis and hence their treatment plan, but it may also provide a therapeutic effect under certain circumstances. In the past, such a procedure required a big laparotomy incision. With the advent of laparoscopic lighting and instrument, laparoscopic lymphadenectomy became popular since the late 1980s. Dargent et al. published the first report on laparoscopic staging in cervical cancers, and many studies then followed. To date, there are numerous case series and trials evaluating the efficacy and safety of laparoscopic surgery in managing gynaecological cancers. In general, compared with laparotomy, laparoscopic lymphadenectomy has less intraoperative blood loss and post-operative pain, fewer wound complications, shorter length of hospital stay and more speedy recovery. However, this is at the expense of longer operative time. The incidence of port-site metastasis is extremely low, although it may be higher in advanced ovarian cancer. Preliminary data showed that there was no significant effect on recurrence and survival, but long-term data are lacking. In this article, the roles of laparoscopy in staging of uterine, cervical and ovarian cancers, the three most common gynaecological cancers, will be reviewed. Novel technologies such as robot-assisted surgery, single-port surgery and sentinel node biopsy will also be discussed.

Port-site metastases in patients with gynecological cancer after robot-assisted operations.

Port-site metastasis is an extremely rare event in patients with cancer treated with robotic-assisted surgery. However, as robotic procedures are increasing, the incidence of port-site metastases might also increase. The purpose of our review is to evaluate the up-to-now existing literature data on robotic port-site metastasis in the field of gynecological oncology. The authors retrieved the included results of the study after performing a systematic search in PubMed, Scopus, and Cochrane Library. In total, 20 patients were included in the study. The mean age of them was 56.3 (range 27-82) years. In the majority of the cases, endometrial cancer was responsible for port-site recurrences. The port-site metastasis occurred after 1-36 months postoperatively with the tumor measuring from 0.8 to 10.5 cm. As far as the management of this type of local recurrence, the most common therapeutic strategy adopted was the local excision followed by combined radiotherapy/chemotherapy. Robotic surgery is a rather new technique and port-site metastasis is a rare complication of it. Due to this fact, we could not reach safe conclusions. The purpose of this study was to raise doctor's clinical suspicion level to such a rare complication. Additional studies should be performed with the intention to clarify both port-site metastasis rates in gynecological oncology patients, as well as to elucidate the possible mechanisms of this type of local recurrence.

Port site metastasis after robotic-assisted laparoscopic hysterectomy for uterine cervical cancer: A case report and literature review

ObjectiveThe incidence of port site metastasis after robotic-assisted laparoscopic surgery for cervical cancer is not well known. According to recent studies of gynecological malignancies, the reported incidence is low and comparable to the results of conventional laparoscopic surgery. Here, we report the case of a patient who suffered port site metastasis after robotic-assisted laparoscopic hysterectomy for stage IB1 uterine cervical cancer. Case reportThe current case is, as we know, only the third episode of port site metastasis after robotic-assisted laparoscopic surgery for cervical cancer documented in the medical literature. Following diagnosis of the port site metastasis, the patient was treated with concurrent chemoradiotherapy (CRT) and experienced a remarkable early response. We reviewed the patient's medical chart and imaging studies, and searched the Medline database to evaluate the incidence, prognosis and treatment outcomes of such cases of port site metastasis in uterine cervical cancer patients. ConclusionCRT resulted in a rapid decrease in tumor size and relief of abdominal pain in our patient. CRT might be considered as a salvage or palliative modality in patients with port site metastasis and/or locoregional recurrence.

Port‐site metastases following robot‐assisted laparoscopic surgery for gynecological malignancies

To evaluate the incidence and possible predictors associated with port-site metastases following robotic surgery. Prospective study. University Hospital. Women with gynecological cancer. The occurrence of port-site metastases in the first 475 women undergoing robotic surgery for gynecological cancer was reviewed. Rate of port-site metastases. A port-site metastasis was detected in nine of 475 women (1.9%). Eight women had either an unexpected locally advanced disease or lymph-node metastases at the time of surgery. All nine women received postoperative adjuvant therapy. Women with ≥ stage III endometrial cancer and women with node positive cervical cancer had a significantly higher risk of developing a port-site metastasis, as did women with high-risk histology endometrial cancer. Port-site metastases were four times more likely to occur in a specimen-retrieval port. One (0.2%) isolated port-site metastasis was detected. The median time to occurrence of a port-site metastasis was 6 months (range 2-19 months). Six of the nine women (67%) have died and their median time of survival from recurrence was 4 months (range 2-16 months). In women with gynecological cancer, the incidence of port-site metastases following robotic surgery was 1.9%. High-risk histology and/or advanced stage of disease at surgery seem to be contributing factors.

Low incidence of port-site metastasis after robotic-assisted surgery for endometrial cancer staging

Low incidence of port-site metastasis after robotic-assisted surgery for endometrial cancer staging

The Incidence of Port Site Metastasis in Robotic Gynecologic Oncology

A port site metastasis is the recurrence of disease at a trocar site following laparoscopic surgery for malignancy. This study determined the rate of port site metastasis after robotic gynecologic oncologic surgery.

Incidentally Detected Gallbladder Cancer- The Controversies and Algorithmic Approach to Management

Incidentally discovered gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diagnosed during or after the cholecystectomy done for unsuspected benign gallbladder disease. Laparoscopic cholecystectomy (LC) is the most common procedure performed for benign gallbladder disease worldwide. Majority of GBC patients have associated gallstones. With the advent of ultrasonography more patients are being diagnosed with gallstones and are being subjected to cholecytectomy. IGBC is found in 0.2-2.9% of all cholecytectomies done for gallstone disease. It represents 27-41% of all GBC. Patients with IGBC having Tis and T1a stage, with negative cystic duct margin can be treated by simple cholecystectomy alone. Patients with stage T1b and beyond should undergo restaging, and should be treated with radical re - resection (R0). Residual disease is found in 40-76% patients on re-exploration. The survival rates of patients undergoing re resection for IGBC is similar to those undergoing primary radical surgery. LC is contraindicated in patients with GBC. Patients presenting post LC should undergo radical re- resection and additional port site excision, as they have a high incidence of port site metastasis. At cholecystectomy for benign gallbladder disease all gallbladder specimens should be opened before closing abdomen and if available all suspicious specimens should be sent for immediate frozen section. All gallbladder specimens should be subjected to histopathology examination to avoid missing GBC. The surgeon should have a high index of suspicion for GBC if encountering difficult cholecystectomy for a benign disease, and in patients with atypical clinical and ultrasound findings in high incidence areas.

Incidence of port-site metastasis after undergoing robotic surgery for biliary malignancies

To investigate the incidence of clinically detected port-site metastasis (PSM) in patients who underwent robotic surgery for biliary malignancies. Using a prospective database, the patients undergoing fully robotic surgery for biliary malignancies between January 2009 and January 2011 were included. Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about PSM. Sixty-four patients with biliary tract cancers underwent robotic surgery, and sixty patients met the inclusion criteria. The median age was 67 year (range: 40-85 year). During a median 15-mo follow-up period, two female patients were detected solitary PSM after robotic surgery. The incidence of PSM was 3.3%. Patient 1 underwent robotic anatomatic left hemihepatectomy and extraction of biliary tumor thrombi for an Klatskin tumor. She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar. Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer. She had two metachronous subcutaneous mass situated at the right lateral abdominal wall under a same trocar scar at 7 and 26 mo. The pathology of the excised PSM masses confirmed metastatic biliary adenocarcinoma. The incidence of PSMs after robotic surgery for biliary malignancies is relatively low, and biliary cancer can be an indication of robotic surgery.

Laparoscopic Port-Site Metastasis in Urologic Surgery

Port-site metastasis has been an increasing concern with the spread of laparoscopy in managing urologic malignancies. The purpose of this study was to provide a current review of port-site metastases reported in the urologic oncology literature, as well as etiologic factors and preventative measures. A comprehensive Medline search (up to September 2007; subject headings: "neoplasm seeding," "laparoscopy," "urologic neoplasms") of all case reports and series related to laparoscopic urology surgery for malignant disease was performed. The references for each of these case reports and series were also reviewed for any additional reports of port-site metastases. Only 28 cases of port-site metastases involving urologic malignancies have been reported, with laparoscopic procedures involving upper tract transitional cell carcinoma comprising the majority (11/28 or 39%) of these. Recent reports involving renal cell carcinoma, prostatic carcinoma, and bladder cancer have been published as well. The incidence of port-site metastases is comparable with that seen following open surgery. The etiology is likely multifactorial, but adhering to proper surgical technique is the most effective preventative strategy.

Outcome of laparoscopic surgery in colorectal cancer: a critical appraisal

Despite the wide application of laparoscopic surgery for various common surgical conditions, the development of laparoscopic colorectal surgery has been slow. The obstacle for its advancement is formed by a steep learning curve and concerns about the oncologic safety in cases of malignant diseases. With refinement in instrumentation and improvement in surgical techniques in recent years, laparoscopic colectomy has become a safe and feasible procedure. The short-term advantages in terms of quicker recovery of bowel function, less postoperative pain and shorter hospital stay of laparoscopic colectomy over conventional treatment seem to be indisputable. Results from large prospective randomized trials revealed the oncologic outcome to be comparable between the two treatments. Furthermore, the incidence of port-site metastasis was shown to be similar between the two approaches. For rectal cancer, laparoscopic-assisted total mesorectal excision has been shown to be a safe and feasible procedure. The incidence of postoperative morbidity including anastomotic leakage appears to be comparable between the two treatments. However, the long-term outcome especially for local recurrence and overall survival remains uncertain. Prospective randomized study with long follow-up is required to elucidate this issue.

Effect of types of resection and manipulation on trocar site contamination after laparoscopic colectomy: An experimental study in rats with intraluminal radiotracer application

The etiology and incidence of port-site metastases after laparoscopic surgery for colorectal cancer remain unknown. The purpose of this experimental study was to detect and quantify the amount of contamination at the port-site by means of a method utilizing radiolabelled colloid particles following extra- or intracorporeal laporoscopic resection of cecum. Prior to experimental surgery, we obtained a high concentration of luminal colonic radiotracer activity by per anum application of sulphur colloid molecules labelled with Tc-99m pertechnetate. In three main groups of rats, we either resected a portion of cecum extracorporeally or intracorporeally, or did no resection. Each main group was further divided into two subgroups, in which the manipulations were either autraumatic or traumatic. We excised trocar sites as 2 cm doughnuts after completion of the surgical procedure. We used gamma camera imaging to quantify the amount of radioactive contamination at trocar sites. The background corrected trocar site activity for each rat was calculated. Activities exceeding the maximum background activity were accepted as trocar site contamination. We detected an overall incidence of contamination in 44% of rats. This rate were 71% and 17% in traumatic and atraumatic subgroups. The resection itself increased the rate and intensity of contamination, as well (p = 0.04). The most intensive contamination was detected in the intracorporeal resection with traumatic manipulation subgroup (p = 0.0007). Both the presence of resection and manipulative trauma seemed to be increasing the rate and intensity of the radioactive activity at the trocar site. When traumatic manipulatiun was exercised, the contamination was so intense that the type of resection did not differ. We concluded that our scintigraphic method would be useful in the intraoperative detection of port site contamination by the tumor cells, and that surgeons would take some preventive measures to prevent future port-site metastases.

P-879 Incidence of port site metastasis following vats lung cancer surgery

P-879 Incidence of port site metastasis following vats lung cancer surgery

Impact of taurolidin and octreotide on liver metastasis and lipid peroxidation after laparoscopy in chemical induced ductal pancreatic cancer

There is controversial discussion whether metastasis initiated by laparoscopy with carbon dioxide might be prevented by instillation of taurolidin or radical scavengers like the somatostatin analogue Octreotide. Therefore we evaluated the effects of laparoscopic lavage with taurolidin and Octreotide on liver metastasis after staging laparoscopy in ductal pancreatic cancer. In 60 Syrian hamsters pancreatic adenocarcinoma was induced by weekly subcutanous injection of 10 mg N-nitrosobis-2-oxopropylamin/kg body weight for 10 weeks. In the 16th week laparoscopic staging biopsy by use of carbon dioxide was performed. Finally animals underwent abdominal irrigation with saline (gr.1, n = 20), taurolidin (0.5%) (gr.2, n = 20) or Octreotide (gr.3, n = 20). In week 25 animals were sacrificed, pancreas and liver were analysed. Size of pancreatic carcinomas was decreased in the taurolidin gr. compared to the other two groups. Furthermore the number of liver metastasis per animal was reduced after lavage with taurolidin (2 +/- 2) and Octreotide (2.5 +/- 2) compared to saline irrigation (4 +/- 4) (p < 0.05). Additionally the incidence of port site metastases was significantly reduced in the taurolidin group. Activity of antioxidative enzyme superoxide dismutase (SOD) was increased while concentration of products of lipidperoxidation was decreased in non-metastatic liver after taurolidin irrigation compared to saline or Octreotide irrigation. Taurolidin irrigation during laparoscopy might be a new concept to reduce the number of liver metastasis and port site metastases in pancreatic cancer.

Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival

Objective. The impact of laparoscopic surgery on the patterns of recurrence and on prognosis in patients with endometrial cancer remains unclear. The objective of the current study was to evaluate the effect of the laparoscopic approach on patterns of recurrence, disease-free (DFS), and overall survival (OS) in patients with endometrial cancer. Methods. A retrospective review of patients presenting with stages 1–4 endometrial cancer who had a hysterectomy, bilateral salpingo-oophorectomy with or without surgical staging was performed. Patients either had a total laparoscopic hysterectomy (TLH) or a total abdominal hysterectomy (TAH). Patterns of recurrence, DFS and OS were the study endpoints. Results. The surgical intent was TLH in 226 patients (44.3%) and TAH in 284 patients (55.7%). TLH was converted to laparotomy in 11 patients. Patients for TLH were younger, heavier, and had a higher ASA score and were more likely to present with early-stage, well-differentiated tumors and were less likely to have undergone lymphadenectomy. Median follow-up was 29.4 months. DFS and OS were adversely and independently affected by increasing age, higher stage, higher grade, and by deeper myometrial invasion, whereas the intention to treat (TLH vs. TAH) did not influence DFS or OS. Patterns of recurrence were similar in both groups and no port-site metastasis was noted in the TLH group. Conclusions. The incidence of port-site metastasis in early-stage endometrial cancer treated by TLH is low. Laparoscopic management does not seem to worsen the prognosis of patients with endometrial cancer.