Port Site Metastases: Where are we at the Beginning of the 21st Century ?

Abstract

Following the introduction of minimal invasive surgery in the field of malignant disease, a number of reports have been published describing the occurrence of tumour deposits in the abdominal or thoracic wall at the sites of trocar placement. These trocar site metastases have caused great concern among minimal invasive surgeons and have put an important restraint on the rapid development of these techniques in oncologic surgery. The present review article focuses on the clinical facts and experimental studies that have been conducted on the problem of port site metastases, more specifically upon their occurrence and pathogenesis. Although most of the port site recurrences are due to technical surgical problems and can be avoided by adapting the same oncologic surgical principles as in open surgery, some features of the minimal invasive techniques facilitate tumour growth and should be kept in mind when performing minimum invasive surgery for malignancy.

Cirugía del carcinoma de colon por vía laparoscópica

“…Tanto en diversas series como en la nuestra, con un seguimiento de más de 5 años, no se ha presentado ningún caso de implante tumoral parietal 6,8 . Según Hubens 14 , que se basa en observaciones clínicas y en investigación experimental, queda claro que las metástasis en los orificios de los trócares no son un mito sino una realidad. Sin embargo, que su aparición sea más frecuente que las metástasis en la pared abdominal de pacientes laparotomizados, no está probado.…”

Prevention of Port-Site Metastasis in Gynecologic Malignancies

“…• Preoperative measures 7,25 -Proper patient selection -Avoidance of laparoscopic surgery, if ascites is present -Compliance guidance and adequate equipment for advanced laparoscopic surgery -Knowledge of the principles of prevention in the event of intraoperative discovery of malignant disease -Adequate duration of the procedure -Proper training of the surgeon • Technical measures 1,3,[25][26][27][28] -Protected puncture of ovarian cyst -Resection without rupture of an ovarian cyst (in case of rupture-aspiration and extensive washing) -Minimal tumor manipulation -Resection of the tumor with adequate margin -Peritoneal lavage with heparin in order to avoid adhesion of free cells or lavage with cytocidal solutions -Use of protective bags for tissue retrieval -Avoiding CO 2 leaks and sudden desufflations -Use of heated and humidified CO 2 -Exsufflation of the peritoneum before removal of the ports -Drainage placement, if needed, before abdomen deflation -Irrigation of ports with heparin or povidone-iodine solution before removal -Administration systemic or intraperitoneal of methotrexate -Closure of all abdominal layers including the peritoneum -Early chemotherapy.…”

Prevention from port-site metastasis

“…In the preoperative measures there are proper patient selection, avoidance of laparoscopic surgery in the presence of ascites, compliance guidance and adequate equipment for advanced laparoscopic surgery, knowledge of the principles of prevention in the event of intraoperative discovery of malignant disease, adequate duration of the procedure and the proper training of the surgeon [2][3][4]. In the technical measures, there are protected puncture of ovarian cyst, resection without rupture of an ovarian cyst, minimal tumor manipulation, resection of the tumor with adequate margin, peritoneal lavage with heparin to avoid the adhesion of free cells or lavage with cytocidal solutions, use of protective bags for tissue retrieval, avoiding CO 2 leaks and sudden desufflations, use of heated and humidified CO 2 , exsufflation of the peritoneum before removal of the ports, drainage placement (if needed) before abdomen deflation, irrigation of the ports with heparin or povidone-iodine solution before removal, administration systematic or intraperitoneal of methotrexate, closure of all abdominal layers including the peritoneum and early chemotherapy [2,[4][5][6][7][8][9]. The authors mention some of them.…”