Port Site Recurrence Research Articles

Nodular fasciitis growing at the port site of robotic surgery for rectal cancer

BackgroundNodular fasciitis (NF) is a type of rare and rapidly growing tumor that affects the muscular fascial layers. Due to its locally aggressive nature and rapid growth, NF can be mistaken as a malignant process on either clinical or histological grounds.Case presentationA 61-year-old man was affected by rectal cancer. We performed a robotic, high-anterior resection with lymph node dissection. According to the 8th edition of Union for International Cancer Control, the diagnosis was stage I pT2N0M0. During a routine follow-up 1.5 years after the robotic surgery, a computed tomography examination revealed a tumor in the upper right abdominal wall, at the site of the surgical port, that measured 45 mm. Magnetic resonance imaging indicated a hypo-intensive mass within the right straight muscle of the abdomen. Port site recurrence following the robotic surgery for rectal cancer was suspected, and an ultrasound-guided fine-needle aspiration was performed; it revealed a low-grade myofibroblastic tumor or benign neoplasm, but was inconclusive. We performed an excision of the lesion, and histopathology confirmed NF, seen as a solid, nodular, spindle-cell lesion. The patient was postoperatively followed for more than 1 year without any sign of recurrence of either cancer or NF.ConclusionsNF is histologically benign, but local recurrence frequently occurs. We encountered a patient with NF at the port site after robotic surgery for rectal cancer.

This Month in Adult Urology

This Month in Adult Urology

Treatable solitary giant port site metastasis following cholecystectomy for carcinoma gall bladder

Patients who are incidentally diagnosed to have carcinoma of the gall bladder following a laparoscopic cholecystectomy are potentially at risk of developing port site metastasis. Port site recurrence is often associated with peritoneal metastases. Here we have presented a case, where a single large port metastasis without peritoneal disease was excised with satisfactory outcomes in terms of surgery, cosmesis and overall survival. A 45-year old lady following a routine laparoscopic cholecystectomy was incidentally diagnosed to have adenocarcinoma of gall bladder (T2). She was then referred to our center where she had a radical cholecystectomy with nodal clearance (N0). Two years later, she presented with a large port site metastasis. PET-CT showed uptake only at the lump and attempt to downsize the tumor with chemotherapy was unsuccessful. Following excision, the 15cm defect in the anterior abdominal wall was reconstructed using a composite mesh. Skin cover was provided using a local rotation 􀏐lap. Fifteen months later, the patient is disease free. Port site excision during de􀏐initive resection is not mandatory as it has not been shown to be associated with improved survival. In this case, due to absence of disease elsewhere, aggressive surgical resection was undertaken for the large port site recurrence.

An analysis on the technical feasibility of laparoscopic excision of intra-abdominal tumors observing the principles of safe removal

The safety of laparoscopic management of pediatric intra-abdominal tumors is often questioned. We analysed our ongoing experience with intra-abdominal tumors managed laparoscopically at our institute from July 2013 onwards. Total 21 children (12 males, 9 females) who presented to us with pediatric intra-abdominal tumors were included. The tumors included Wilms tumor (n = 13), neuroblastoma (n = 3), adrenal cortical tumor (n = 2), ovarian tumor (n = 2), and pheochromocytoma (n = 1). Children were between 10 months and 14 years. A three- or four-port laparoscopic nephrectomy and lymph node sampling for Wilms tumor, adrenalectomy for adrenal tumors, and oophorectomy for ovarian tumor were performed. The tumors were removed in toto with no rupture (except in one). Specimens were retrieved through a lumbar incision (n = 19), pfanninsteil incision (n = 2). No case was converted to open surgery. All the children are under regular follow-up. One child with Wilms tumor had local recurrence. One child had port-site recurrence which required port tract excision. One child with neuroblastoma underwent open surgery for recurrence during follow-up. No mortality was recorded in this study group. Laparoscopy or laparoscopic-assisted removal of pediatric intra-abdominal tumors is a feasible and safe option. It has the advantage of less post-operative pain, shorter hospital-stay, and a better cosmetic result. Proper patient selection, port placement, and surgeons’ laparoscopic experience are contributory.

Cutaneous port-site recurrence secondary to tumour seeding following implantation of an intraperitoneal chemotherapy access port for gastric cancer.

Intraperitoneal chemotherapy has shown promising results for the treatment of peritoneal carcinomatosis in gastric cancer. However, the implantation of an intraperitoneal chemotherapy port may be associated with catheter-related complications. The authors describe a case of cutaneous port-site recurrence secondary to tumour seeding from an intraperitoneal chemotherapy access port.

Port site recurrence of esophageal adenocarcinoma after minimally invasive esophagectomy: a case report

BackgroundPort site recurrence has been observed after a variety of oncologic resection procedures. However, few have reported port site recurrence of esophageal cancer.Case presentationA 51-year-old man underwent minimally invasive esophagectomy for pT3(AD)N3M0 adenocarcinoma of the esophagus. One year after surgery, he presented with a rapidly growing tumor on the right thoracic wall. Contrast computed tomography demonstrated an enhancing tumor with uptake on positron emission tomography. We performed resection of the thoracic wall, including the skin and subcutis. The pathologic diagnosis was poorly differentiated adenocarcinoma, consistent with metastasis of esophageal origin.ConclusionThis was the first report on thoracic port site recurrence of esophageal adenocarcinoma. We recommend elimination of leakage around the thoracoscopic ports to prevent such recurrence. We should provide prudent postoperative clinical surveillance.

Axillary metastases after port site recurrences of gallbladder carcinoma: a case report

BackgroundIncidental gallbladder carcinoma is often discovered after elective laparoscopic cholecystectomy for cholecystitis or cholecystolithiasis. Port site recurrences may occur. Patients with port site metastases of gallbladder carcinoma have a poor prognosis.Case presentationA 61-year-old man underwent an elective laparoscopic cholecystectomy because of cholecystitis and gallstones. Pathology revealed a gallbladder carcinoma. After referral to a tertiary center, radical re-resection followed.Three years later, an epigastric port site recurrence emerged, partially fixed to the xiphoid process. A wide abdominal wall resection was performed, including part of the xiphoid process. Follow-up was continued with periodical imaging and standard blood work.Three years after resection of this port site metastasis, the patient presented with an occasionally painful mass in the left axilla. Pathology revealed the presence of an adenocarcinoma, most likely arising from the prior gallbladder carcinoma.Given the extensive dissemination and limited symptoms in the axillary node, we decided against a surgical intervention, instead of adopting a wait-and-see policy. Disease progression occurred within 1 year, and the patient was treated with palliative radiotherapy, followed by palliative chemotherapy.The patient died of metastatic disease approximately 6.5 years after the initial cholecystectomy.ConclusionsPort site recurrences of (incidental) gallbladder carcinoma occur after laparoscopic cholecystectomy, despite preventive perioperative measures. Patients with port site recurrences can develop axillary lymph node metastases, similar to other truncal malignancies. Surgical interventions should be limited.

MP49-12 RECURRENCES AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM

INTRODUCTION AND OBJECTIVE:There have been concerns about higher incidence of local recurrence after robot-assisted radical cystectomy (RARC) compared to its open counterpart. We sought to report a...

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort.

To investigate oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer in a Japanese multicenter cohort, and to explore the risk factors associated with recurrences due to tumor dissemination. Laparoscopic radical cystectomies carried out at 10 institutions were included in this retrospective study. Multivariate analyses were carried out to identify the clinical parameters associated with overall recurrences together with specific recurrence types. Kaplan-Meier curves were created to elucidate time to recurrence and survival. A total of 411 patients were included after the final analysis. Postoperative pathology was T2 or higher in 196 patients (48%), and lymph node metastasis was present in 46 patients (11%). The median follow-up period was 23months, and the 2-year recurrence-free and cancer-specific survival rates were 71.0% and 84.7%, respectively. The recurrence sites involved distant metastasis in 75 patients (18%), local recurrence in 52 patients (13%) and urinary tract recurrence in eight patients (2%). When local recurrence at the cystectomy bed (28 patients; 7%) and abdominal recurrence including peritoneal carcinomatosis or port site recurrence (17 patients; 4%), which might be caused by tumor dissemination, were combined into a single group, prolonged surgical time was a significant risk factor, in addition to high pathological stage (T3-4 and/or positive lymph nodes), positive surgical margins, and variant histology by both univariate and multivariate analyses. Our study findings suggest that recurrences after laparoscopic radical cystectomy might be caused by tumor dissemination, and attention should be paid to avoid prolonged surgical time in laparoscopic radical cystectomy.

Two Cases of Portsite Recurrence after Laparoscopic Surgery for Colorectal Cancer

Two Cases of Portsite Recurrence after Laparoscopic Surgery for Colorectal Cancer

A case of Schloffer tumor with rapid growth and FDG-PET positivity at the port site of laparoscopic sigmoidectomy for colon cancer

BackgroundSchloffer tumor is a foreign body granuloma in the abdominal subcutaneous layer that develops due to a foreign body such as suture from several months to years postoperatively. Herein, we report a case of a rapidly growing Schloffer tumor with F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) positivity at the port site of laparoscopic sigmoidectomy for colon cancer.Case presentationAn 85-year-old man, who underwent laparoscopic sigmoidectomy for stage IIIa sigmoid colon cancer 10 months ago, was referred to our hospital with complaints of a growing mass in the abdominal wall. The tumor was palpable at the right-sided abdominal wall corresponding to the port site of laparoscopic sigmoidectomy. The tumor rapidly grew for 2 months. Computed tomography showed a ring-enhanced mass at the right-sided abdominal wall. PET examination revealed high accumulation of FDG in the tumor. Tumor resection was performed due to suspected port site recurrence. The pathological diagnosis was inflammatory granuloma, so-called Schloffer tumor.ConclusionIn the era of laparoscopic surgery, Schloffer tumor may be one of the differential diagnoses for rapidly growing tumor with FDG-PET positivity at the port site in postoperative patients with advanced colorectal cancer.

Is single-incision laparoscopic surgery a safe alternative to conventional laparoscopic surgery in colorectal cancer?

Background: Single incision laparoscopic surgery (SILS) has gained popularity due to improved aesthetic benefit, potentially less surgical trauma and decreased post-operative pain than conventional multi-port laparoscopic (CL) surgery. However, research using SILS in colorectal cancer surgery is limited and whether these expected benefits exist and / or outweigh the disadvantages e.g. longer operating times and increased costs (equipment and surgical training). The oncological safety of these laparoscopic techniques including lymph node removal and port-site recurrence also remains unclear.

Port site recurrence and unusual diffuse subcutaneous metastases of unexpected early stage ovarian cancer after laparoscopic surgery: a case report.

Port site recurrence is a rare but well-documented adverse event peculiar to laparoscopic surgery. We report an unusual outcome of unexpected early stage ovarian cancer in which port site recurrence occurred after laparoscopic surgery and was followed by diffuse subcutaneous metastases. A 31-year-old Japanese woman with a large tumor in her abdomen visited our hospital. Because no intratumoral solid component was detected on diagnostic imaging, the tumor was diagnosed as a benign ovarian tumor and the patient underwent left ovarian laparoscopic cystectomy. Contrary to our expectations, however, the ovarian tumor was a mucinous carcinoma. We performed additional surgery, but the tumor recurred in the umbilical area, and multiple subcutaneous metastases later appeared. The curative effect of chemotherapy and radiation was limited. This atypical metastatic distribution of an extremely small amount of cancer might have been caused by the laparoscopic procedure. Protection against tumor cell dissemination is necessary during all forms of laparoscopic surgery.

Axillary Lymph Node Metastasis in Gallbladder Carcinoma with Incidentally Detected Coexistence of Aberrant Right Subclavian Artery with Left-Sided Superior Vena Cava.

The sequential development of port site recurrence, followed by recurrence in the axillary lymph node in gallbladder carcinoma is very infrequently reported in the literature. The representing 18F-fluorodeoxyglucose positron emission tomography-computed tomography image shows a metastatic right axillary lymph node in a case of gallbladder cancer developed following surgical removal of port site recurrence and six cycles of chemotherapy. The image also shows coexistence of two incidentally detected vascular anomalies, i.e., aberrant right subclavian artery and left-sided superior vena cava. Coexistence of both the vascular anomalies is rare among the general population and have their own clinical implications as described.

LAPAROSCOPIC COLORECTAL SURGERY;

Objective: The aim of this study was to assess the outcome of laparoscopiccolorectal procedures performed in a district general hospital within 5 years period and tocompare it with patients who had an open procedure during the same period. Patients andMethods: Data were collected retrospectively from patient’s case notes retrieved from hospitalmedical records. One hundred consecutive cases of laparoscopic colonic resection includingboth benign and malignant diseases between 2005 and 2010 were analysed for perioperativeand long term outcome and were compared with consecutive one hundred cases of opencolectomies. Results: Overall conversion rate was 6% for laparoscopic group. The mean majorcomplication rates in laparoscopic group were 5% (3% in open group) and minor complicationsoccurred in 18% (28% in open group). There was no mortality in either group. The overallmorbidity rate was 23% in laparoscopic group as compared to 31% in open colectomy group. In64 cases, curative laparoscopic resections were performed for colorectal malignancy while 72patients had resections for cancer in open group. The mean lymph node harvest in laparoscopicgroup was 13.2 nodes as compared to 12.4 in open group; no port-site recurrence wasdocumented at a mean follow-up of 26 months. Average duration of surgery was 180 minutes ascompared to 140 minutes in open group. Mean postoperative hospital stay was reduced from 13days to 7 days. (Open Vs. Lap). There was no statistically significant difference in majorcomplication rates and mortality. Conclusions: Laparoscopic colorectal surgery is safe andfeasible in elective colorectal cases and reduces the hospital stay without any added morbidity.

The Utility of Diagnostic Laparoscopy in Patients Being Evaluated for Cytoreductive Surgery and Hyperthermic Peritoneal Chemotherapy.

To assess the role of diagnostic laparoscopy (DL) to evaluate candidates for optimal cytoreduction surgery of peritoneal carcinomatosis (PC) combined with hyperthermic intraperitoneal chemotherapy in a consecutive series. The characteristics of 31 patients undergoing DL between August 2012 and October 2016 for a diagnosis of PC secondary to digestive neoplasms were retrospectively reviewed. Laparoscopic evaluation was successful and well-tolerated in 100% patients (N=31). In 17 patients (54.8%) the PC was deemed unresectable. A cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy was performed in 10 of 12 patients with PC considered resectable at laparoscopy wity a positive predictive value of 83.3%. One patient was diagnosed with more extensive disease than that as assessed by the DL at the time of laparotomy and 1 patient elected not to have further surgery. There were no port-site recurrences and morbidity at mean follow-up of 19.3 months. Laparoscopic assessment of PC is a useful tool to assess the complete resectability of peritoneal surface disease in patients for whom there is inadequate information concerning disease extent. DL also helps selected patients to avoid an unnecessary laparotomy.

Role of laparoscopy in initial tumour staging in advanced epithelial ovarian cancer: A systematic review.

BackgroundThe aim of this systematic review was to investigate the accuracy of additional staging laparoscopy (SL) in advanced epithelial ovarian cancer (AEOC) to predict futile laparotomy (FL).MethodsSystematic review according to preferred reporting items for systematic reviews and meta-analyses statement (PRISMA) criteria. Clinical studies investigating the role of SL in selecting women with AEOC for primary debulking surgery (PDS) were included. Index test: SL. Reference test: laparotomy. Target condition: incomplete cytoreduction (CR) with remaining disease<1 cm.ResultsNine prospective and retrospective studies reporting on eight cohorts totalizing 778 LS were included. Reference test was completed in 76 % cases. PPV for FL was between 0.69 and 1.0. In three studies examining the value of a predictive index value (PIV) for predicting FL, sensitivity of the index test (LS with PIV ≥8) was between 46% and 70 %, and specificity between 89 % and 100 %. The proportion of patients that received CR during PDS differed widely between studies (from 50 to 91). Using a PIV did not increase the sensitivity and might result in more patients receiving FL. In the only randomized trial, FL occurred in 10 (10 %) of 102 patients in the LS group versus 39 (39 %) of 99 patients in the primary PDS group (relative risk, 0.25; 95 % CI, 0.13–0.47; p<0.001). Port-site recurrences occurred in 2%–6 % patients. Overall costs of with or without SL were comparable.ConclusionsThe evidence available from this systematic review supports the inclusion of an additional LS to the conventional initial diagnostic workup in women with AEOC.

Complications of Laparoscopic Morcellation: Two Cases and a Review of the Literature

Abstract Background: Laparoscopic power morcellation has revolutionized laparoscopic surgery by facilitating removal of large uterine masses through small incisions. Recently, there has been a debate on the use of this technique in view of iatrogenic dissemination of myoma tissue necessitating further medical or surgical interventions. Despite meticulous retrieval of all pieces and thorough irrigation, some fragments can elude detection, giving rise to disseminated peritoneal leiomyomatosis or disseminated sarcoma in an undetected malignancy. These complications could require reintervention and may upstage the disease in sarcoma, which worsens patient prognosis. Cases: This article reports on 2 cases with complications after laparoscopic morcellation. The first patient had port-site recurrence of a leiomyoma, 3 years after laparoscopic hysterectomy for multiple uterine fibroids, when specimen was removed by power morcellation. The second patient underwent laparoscopic myomectomy for fibroid uterus and the...

Images: Port site recurrence on followup imaging after adrenalectomy for adrenocortical carcinoma - first indicator of carcinomatosis.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy of the adrenal cortex. Complete surgical resection is essential for localized tumours because ACC is highly resistant to chemotherapy and radiotherapy.1 Use of a laparoscopic approach for adrenalectomy in the setting of a confirmed or suspected ACC is controversial because it is unknown if laparoscopy provides equivalent oncological outcomes compared to an open approach.

Elastofibroma developing at the subscapular port site after thoracoscopic surgery: first case report

In recent years, the number of cancer patients who undergo endoscopic surgery has been increasing, and port-site recurrence is becoming a more common complication. A 66-year-old woman underwent thoracoscopic left lower lobectomy with lymph node dissection for pT1aN0M0 adenocarcinoma of the lung. Six years after surgery, CT revealed a subscapular tumor measuring 3 cm at the site of the surgical port wound. Although port-site cancer recurrence was suspected, needle biopsy revealed that the tumor was an elastofibroma. During 6 months of follow-up, MRI revealed no further change, and it was concluded that development of the tumor at the subscapular port site had been merely coincidental.