Isolated port-site metastasis after surgical staging for low-risk endometrioid endometrial cancer: A case report

Abstract

Abstract. Port-site metastases (PSMs) are well-known potential complications of laparoscopic surgery for gynaecologic malignancies. The present case study reports PSM following laparoscopic surgery for Stage IA Grade 1 endometrioid endometrial cancer (EEC). The recurrence developed within 7 months following primary surgery and required surgical excision followed by adjuvant chemo-radio therapy. After 9 months, the patient remains disease-free. PSMs are rare complications following laparoscopic surgery. Amongst the 23 cases of endometrial cancer PSMs reported so far, only 4 followed EEC Stage IA Grade 1-2. The present study reports a rare case of PSM after Stage IA Grade 1 EEC. The clinical and prognostic relevance of PSMs has not been identified so far; and it is not known whether PSMs represent a local recurrence or a systemic recurrence. Surgeons should be aware that even low-risk EEC may be followed by PSMs and should take steps to prevent these rare recurrences. IntroductionEndometrial cancer (EC) is the most common malignant tumor of the female genital tract in the developed countries of North America and Europe. At diagnosis, endometrioid endometrial cancer (EEC) does not extend beyond the uterus in >75% of cases and is characterized by a good prognosis, with an overall 5-year survival rate of 75-80% (1,2). Histological diagnosis reports in most cases a type 1 EC, termed EEC, which is usually associated with low aggressiveness and long term disease free survival; whereas type 2 EC refers to high-risk neoplasias, such as serous or clear cell EC (1).The current management of EC includes total hysterectomy with bilateral salpingo-oophorectomy (BSO), lymphadenectomy, if necessary, and peritoneal cytology (3). Laparoscopy offers unique benefits including shorter recovery time, improved performance status following surgery and a decreased risk of adhesions when compared with open laparotomy procedures, and is increasingly used as an alternative to abdominal surgery in the management of EC (4).The laparoscopic management of malignancies has also brought about novel, late complications of surgical therapy in the form of tumor recurrences and trocar insertion sites metastases (5). Laparoscopic port-site metastases (PSMs) are early recurrent tumorous lesions developing locally in the abdominal wall within the scar tissue of one or more trocar sites, and can be compared to wound metastases after open surgery. By definition, port site recurrences are not associated with diffuse peritoneal carcinomatosis (5-7).The overall incidence of PSM in gynecologic malignancies has been estimated to be 1-2%, reaching 19.6% in patients with advanced ovarian cancer undergoing diagnostic laparoscopy; PSMs have also been reported in patients with previous EC (8). The purpose of the present case study is to describe a rare case of isolated port-site metastasis following laparoscopic surgical staging for early low-grade EEC and to review all the published cases of PSMs after laparoscopic surgery for EC. Case reportA 57-year-old woman wh...

Port Site Metastasis After Minimally Invasive Surgery in Gynecologic Malignancies: Two Case Reports and a Review of the Literature

“… 41 Early endometrial cancer patients (Stage IA Grade 1) can also develop PSM after laparoscopic surgery. 42 However, most cases have shown that PSM tends to occur in advanced cancer, and patients at risk for recurrence may have a poor prognosis because of their advanced cancer status. However, this theory may not apply to early-stage ovarian cancer.…”

“…5,6 The overall incidence of PSM in gynecologic malignancies has been reported to be 1-2%. [7][8][9] For primary gynecologic tumors with surgical indications, primary surgery is important, and thorough surgery is closely related to patient survival. However, the surgical indications vary among different types of gynecologic malignancies.…”

Recurrence of Mandibular Ameloblastoma on Autogenous Bone Graft: A Case Report

“…25 Reports of surgically-induced seeding in malignancies like, wound metastasis in open surgery and port site metastasis in laparoscopic surgery are becoming an emerging problem for surgeons. 26 However, "benign metastasis" is also possible as evidenced by endometriosis seen in ectopic locations. 27 One interesting report is the development of ameloblastoma on the iliac bone donor site which can only be explained by tumor contamination during the graft harvest.…”

Minimally invasive surgery in gynecological cancers: update and systematic review

“…Regarding the pattern of recurrence, concerns were raised for the hypothetic risk of augmented frequency of vaginal cuff recurrence and the possible localization at the port site [91]. In the analysis conducted in 2012 on recurrence and OS in patients enrolled in the LAP2 study, no statistically significant difference was found in vaginal recurrence between laparoscopy and laparotomy [27].…”