Ovarian Cancer Recurrence at the Laparoscopic Port for Cholecystectomy

Abstract

Cancer recurrence at the laparoscopic ports is a well-known complication of laparoscopic surgery. The frequency of the complication is increasing in recent years because of the popularity of laparoscopic surgery. We report two cases of ovarian papillary carcinoma which recurred at the port of laparoscopic cholecystectomy. The tumor was localized at the portal site with no evidence of metastases at any other site. The patients had laparoscopic cholecystectomy for cholelithiasis some time before the ovarian tumor was diagnosed. This shows that the incidental presence of intraperitoneal cancer and inflation of the abdominal cavity may lead to the seeding of tumor cells even without manipulation of these tumors. This supports the hypothesis that CO 2 gas leads to dispersion of cancer cells, which may then be deposited on the site of the ports. Metastasis through lymphatics to the scar cannot be ruled out. Case Reports Case 1A 64-year-old woman presented to another hospital for chronic cholecystitis for which she had laparoscopic cholecystectomy, which was uneventful. Three years later, she started to have lower abdominal pain. Investigations showed right ovarian carcinoma. Total abdominal hysterectomy and oophorectomy were performed. Six months after the second surgery, she started to feel pain in her upper abdominal wall at the site of the laparoscopic port. CT scan showed thickening of the rectus muscle at the site of the port. She was observed for four months. Repeat CT scan showed the port had a mass at the level of the rectus muscle (Figure 1). Pelvic and liver examinations showed no tumor. Fine-needle aspiration revealed poorly differentiated carcinoma. A wide local excision of the mass was performed. The abdominal wall was reconstructed, using a Marlex mesh. The wound healed completely. Pathologic examination of the resected mass revealed a metastatic adenocarcinoma with areas of necrosis. The morphology of this tumor was compatible with metastasis from previously resected ovarian carcinoma (Figure 2). Review of the slides from the cholecystectomy specimen revealed no neoplasm. Twelve months after surgery, there was no evidence of recurrent tumor. Case 2A 70-year-old woman presented to another hospital because of chronic cholecystitis, for which she had laparoscopic cholecystectomy. Seven months later, she developed a mass at the mid-clavical laparoscopic port. Histopathology report of the excised mass demonstrated metastatic ovarian carcinoma. Investigations showed a 9x7x10 cm adnexal solid mass with ascites. Total abdominal hysterectomy and oophorectomy was performed. Four months later, the patient developed a mass at the same port site. Wide re-excision of the tumor was performed and the abdominal wall was reconstructed using Marlex mesh. The patient had an uneventful postoperative course. Four weeks after surgery, the patient was doing well without any evidence of recurrent tumor.