Port‐site recurrences following laparoscopic operations for gynaecological malignancies

Abstract

Objective To determine the frequency of port-site recurrences following laparoscopic surgical treatment Design Retrospective review of metastatic primary and recurrent gynaecological malignancies.Results Twenty-five women were studied. Twenty-four had metastatic disease at the time of laparoscopic surgery, 22 in association with a primary malignancy (cervix: n = 12, ovary: n = 7, endometrium: n = 3), and two in association with recurrent ovarian cancer; all received pelvic or extended field radiation or chemotherapy after surgery. One woman with Stage IIIC ovarian cancer, disease-free at the completion of neoadjuvant chemotherapy following laparotomy by a general surgeon, was included; she developed scalene node metastases 18 months after definitive laparoscopic surgery. Seventy-one 5 mm trocars and fifty 10 mm trocars (total n = 121) were used for surgery; thirty-one 10 mm trocar sites and forty-four 5 mm sites (total n = 75) received post-operative treatment with chemotherapy (n = 49) or radiation (n = 26). Four women (16%) developed recurrences in association with endometrial (n = 2) and cervical (n = 2) cancer at six trocar sites. All recurrences were associated with abdominopelvic andlor distant metastases, and all occurred at untreated 5 mm trocar sites. The difference in recurrence rates between 5 mm and 10 mm trocar sites (x2 = 6; P < 0.025), and between treated and untreated trocars (x2 = 5 ; P < 0.05) were both statistically significant (McNemar's test), but the effects of treatment and trocar size on the port-site recurrence rate were confounded.Conclusions Port-site recurrences are local manifestations of disseminated disease that result from the enhancement of tumour growth characteristic of healing tissues and can be prevented by appropriate post-operative therapy.of gynaecological malignancies metastatic at the time of surgery.

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

“…Historically the first case of PSM after laparoscopic surgery for EC was reported in 1997 by Kadar et al (9). After 2011, Grabosh and Xynos (10) described 2 cases of isolated PSM after robotic surgery for EEC.…”

“…Moreover, laparoscopic port sites and peritoneal incisions have demonstrated rapid cellular turnover and might provide fertile ground for tumor cells. Other risk factors for the development of port site metastases include ascites and advanced stage (9).…”

Laparoscopic management of early endometrial cancer: current status

“…Port-site recurrence (PSR) has been reported in association with endometrial cancers managed laparoscopically; however, the mechanism of development is not fully understood [50,51]. In most cases these recurrences occur in association with advanced stage disease [41].…”

Possibilities of laparoscopic approach in the treatment of patients with ovarian malignancies

“…Имеются многочисленные публикации, объяс-няющие высокую частоту рецидивирования после лапароскопических операций по поводу РЯ повы-шенным давлением газа в брюшной полости, негер-метичностью установленных троакаров, возможным негативным влиянием самого углекислого газа, труд-ностями соблюдения правил абластики в ходе вме-шательства [9][10][11]. Все эти негативные моменты на-шли подтверждение и в нашем исследовании.…”