Risk of Port Site Metastases

Abstract

Laparoscopy has become more and more popular in the treatment and staging of intra-abdominal tumors, especially in gastroenterology but also in gynecology and general surgery. Oncological patients should also benefit from a minimally invasive approach. However, at the beginning of the establishment of this process in the field of cancer surgery, laparoscopy was overshadowed by specific problems such as tumor recurrence at the site of insertion of the laparoscope (port site metastases) and rapid intraperitoneal tumor dissemination [1–3]. Therefore, the fact of postlaparoscopic metastatic disease at trocar sites and possible enlarged intra-abdominal tumor dissemination slowed down widespread employment of laparoscopic techniques to resect malignant tumors. Many reports have been published since this complication first occurred. Most of these reports show the recurrence of port site metastases after laparoscopic resection of colorectal cancer, diagnostic laparoscopy for digestive cancer, or removal of gallbladder with occult cancer [2]. Incidences of port site metastases associated with laparoscopic colorectal surgery as high as 21% were quoted [2]. These results may be due to poor surgical techniques during early experience in the field. In contrast, some recent studies of larger patient pools have documented incidences of port site recurrences as low as 2% [4–6]. Looking at conventional open surgery in colorectal malignancy we see a very rare incidence of abdominal recurrence. Here incidence is quoted as 0.69% or higher, with 3.3% in patients that were operated conventionally by laparotomy and in whom recurrences were recorded 3 months after operation [7, 8]. By the end of 1997 there were 164 published cases of laparoscopic and thoracoscopic tumor seeding.