Port site metastases

Abstract

The risk of port site metastases remains low, provided that surgeons rigorously adhere to the principles of oncological surgery.

Port-Site Metastasis after Laparoscopic Surgery for Urological Malignancy: Forgotten or Missed

“…However, it is logical to assume that morcellation of the specimen increases tumor seeding [5, 6, 15]. The direct dissemination of tumor cells from contaminated material or from extraction with an unclosed bag is well documented [5, 6, 15].…”

“…When they occur, they often do so in the presence of advanced disease, but it is not uncommon for them to occur in isolation [5, 6]. Concern has been expressed that laparoscopic surgery might adversely affect the long-term outcomes by increasing the risk of port-site and peritoneal seeding.…”

Port-site metastases in patients with gynecological cancer after robot-assisted operations

“…More specifically, in that case series, in women with gynecological cancer, the presence of port metastases was most common in high-risk histological types including clear-cell, neuroendocrine cancer or carcinosarcoma [5]. Port-site metastases also seem to be improbable as a result of hematogenous or lymphatic spread [16]. Wound-related factors, such as an alteration in macrophage function and the local and systemic immune response to the pneumoperitoneum, could also be related to port metastases, even though physiology is not yet entirely clarified [17][18][19].…”

“…Moreover, a subcutaneous emphysema could also be related with a potential rise in port metastasis rates [10]. Finally, in cases of incidental finding of malignancy in fibroid specimens, morcellation increases tumor seeding [16,23].…”

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

“…Literature reviews published in 2008 reported 28 cases of port-site metastases following urologic oncology procedures. [2][3][4] The pathophysiological theory surrounding port-site recurrence is debated but currently focuses on tumour seeding into the incisions at the time of surgery by direct tumour contact with the wound, or surgical instruments that have been contaminated. …”