Portmetastasen: Fakt oder Fiktion?

Abstract

In the early 1990s, the first reports appeared indicating a disturbingly high incidence (20%) of port site metastases following laparoscopic procedures for visceral and gynecological malignancies. At the same time, animal experiments were performed to investigate the phenomenon of port site metastases. The results were independently and repeatedly verified by different groups. In view of these distressing facts, a controversial, at times emotional discussion arose that evolved at least in part without strict regard to the available data. In the recent past, reports on increased incidence of port site metastases after laparoscopic interventions have completely vanished from the literature. Figures on incidence reported by various authors range between 0.5% and 1.3% and thus are comparable to the rate for surgical wound metastases (0.8-1.6%) as known from open conventional methods. Prospective studies have even shown that the survival rate in comparison to conventional techniques is 20% better, at least for laparoscopically treated stage I-III colorectal carcinomas. At present the discussion on the phenomenon of port site metastases can be considered closed. Port site metastases are thus no longer a fact, but also not fiction, since this phenomenon does occur in a small percentage of patients after laparoscopy just as after open surgery.

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

“…The incidence of tumour seeding in general laparoscopic surgery ranges from 0.8% to 21% (8, 9). However, most authors report an incidence of 0.5%, comparable to the rate for surgical wound metastases (0.8%–1.6%) in conventional open methods [9–11]. In recent years, several reports of port-site metastasis and tumor seeding have been published.…”

“…Wound-related factors [11–17]: local and systemic immune response to the pneumoperitoneum has been suggested. Its physiopathological mechanism has yet to be completely defined.…”

“…Its physiopathological mechanism has yet to be completely defined. There is a tendency towards systemic preservation of the immune system and towards immune depression of the peritoneum during laparoscopic insufflation demonstrated by macrophage function alteration [11–17]. …”