Port site recurrences after laparoscopy for malignant disease

Abstract

Reports of recurrent malignant disease developing at laparoscopic port sites has created considerable controversy among surgeons. Many have implicated the technique of laparoscopy as a cause of metastases and this has led to condemnation of laparoscopy in malignant disease by many surgeons. A review of the case reports, as well as animal studies, reveals the problem to be considerably more complex. Based on experimental models, reported cases, and our experience at the University of Texas M. D. Anderson Cancer Center, we have arrived at some substantive conclusions regarding this phenomenon. Port site recurrences (PSRs) after laparoscopy for malignant disease can occur as the only site of recurrence, but this is an extremely rare event, and the incidence does not appear to be significantly different from the development of wound recurrences after open laparotomy for malignancy. It is likely that port site recurrences reflect the underlying biology of the malignant disease, rather than an effect of the technique of laparoscopy. Semin. Surg. Oncol. 16:307–312, 1999. © 1999 Wiley‐Liss, Inc.

Influence of laparoscopy on postoperative recurrence and survival in patients with ruptured hepatocellular carcinoma undergoing hepatic resection

“…Literature review before 1998 reported at least 160 cases of port‐site recurrence after diagnostic laparoscopy or laparoscopic resection of intra‐abdominal cancers8, although this seems to be less problematic now, with increasing experience in laparoscopic surgery31. The present results concur with studies that suggest no adverse effect of diagnostic laparoscopy in patients with malignant disease17, 32.…”

Laparoscopy alone is superior to peritoneal cytology in staging gastric and esophageal carcinoma

“…Close examination of port-site recurrence events has identified that most (>50%) are associated with widespread cancer recurrence, and the port-site recurrence in our patient was identified at the same time widespread carcinomatosis was detected. Thus, port-site recurrence is a risk associated with diagnostic laparoscopy for gastrointestinal malignancies; however, its identification rarely alters patient outcome, and we believe the potential risk of port-site recurrence is outweighed by the proven benefit of staging laparoscopy [12].…”

Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach

“…While the mechanism of this phenomenon has not been clarified, investigators have speculated that it is probably caused by some combination of the following factors: (1) tumor manipulation; (2) failure to isolate the tumor; and (3) forceful extraction of the surgical specimen [13][14][15][16]. The literature has yet to report any such recurrences after laparoscopic radical gastrectomies.…”