The pathogenesis of port-site recurrences

Reymond, Marc A.; Schneider, Claus; Kastl, S.; Hohenberger, Werner; Köckerling, F.

doi:10.1016/s1091-255x(98)80030-9

“…In 1978 the first reported case of tumor metastases at the site of cannula insertion following diagnostic laparoscopy for malignant ascites was published [8] and since then more than 160 cases of abdominal wall metastases after minimally invasive procedures have been reported [28]. Although the reported incidence of port site metastases ranges between 1% and 21%, recent data seem to indicate that the incidence is rather low and ranges between 0 and 1.2% [26].Hematogenic as well as lymphatic spread and direct implantation of cancer cells liberated during laparoscopic tumor resection have been discussed as possible mechanisms of wound metastases. Because of the large number of malignant cells in the abdominal cavity and on the surgical instruments found after laparoscopic procedures, direct implantation seems to be the most likely mechanism [22].…”

mentioning

confidence: 99%

“…In 1978 the first reported case of tumor metastases at the site of cannula insertion following diagnostic laparoscopy for malignant ascites was published [8] and since then more than 160 cases of abdominal wall metastases after minimally invasive procedures have been reported [28]. Although the reported incidence of port site metastases ranges between 1% and 21%, recent data seem to indicate that the incidence is rather low and ranges between 0 and 1.2% [26].…”

mentioning

confidence: 99%

Impact of laparoscopic gases on peritoneal microenvironment and essential parameters of cell function

Wildbrett

¹

,

Oh

²

,

Naundorf

³

et al. 2003

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“…In order to develop a PSR, viable tumor cells must be liberated from the primary tumor, be transported to the trocar wound, and find there a favorable environment for growth [42]. Thus, in theory, PSRs might be secondary to multiple factors including the biologic properties of the tumor, manipulation of such a tumor, the gas used, local trauma in the wound, individual surgical skills, etc.…”

Section: Pathogenesismentioning

confidence: 99%

“…In the clinical setting, experience and surgical expertise seem to be the best prevention of the occurrence of PSRs. The short clinical delay in the occurrence of PSRs (median 190 days in colorectal cancer) suggests a massive cell seeding into the abdominal wall (over 10 6 cells) during the operation [42]. In the human patient, such large numbers of tumor cells have been demonstrated in peritoneal fluids, on surgical instruments and trocars, but not in the CO 2 [6].…”

Section: Pathogenesismentioning

confidence: 99%

Tumor Cell Dissemination during Laparoscopy: Prevention and Therapeutic Opportunities

Steinert

¹

,

Lippert

²

,

Reymond

³

2002

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Port-site recurrences (PSRs) are abdominal wall recurrences that occur in the subcutaneous tissue within a trocar site after cancer laparoscopy and are not associated with peritoneal carcinomatosis. In order to develop PSRs, viable tumor cells must be liberated from the primary tumor, be transported to a wound, and find there a favorable environment for growth. The short clinical delay in the occurrence of PSRs and their size suggest massive cell seeding into the abdominal wall. Traumatic handling of the tumor, slipping of trocars, liquid projection, as well as poor extraction techniques can all cause implantation of malignant cells into the subcutaneous tissue. Such contact can also occur postoperatively if the trocar channels remain open. Some histologies (e.g. gallbladder adenocarcinoma), the presence of ascites and advanced tumor stage are risk factors for PSRs. Further conditions – including the use of gas – might also play a limited role. The first preventive measure is the correct indication for a laparoscopic approach. Several techniques have been demonstrated to prevent PSRs in the animal model: (a) fixation of trocars to the abdominal wall; (b) prevention of leakage; (c) careful specimen handling; (d) reducing trauma to the abdominal wall; (e) specimen isolation before extraction from the abdominal cavity; (f) trocar-site irrigation with a cytotoxic solution, and (g) closure of peritoneum. Further innovative therapies are currently under investigation. In the clinical setting, correct indication, surgical expertise and application of prophylactic measures seem to be the best way to prevent the occurrence of PSRs.

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“…Port site metastases are not associated with diffuse peritoneal carcinomatosis. 1 The first reported case of a port site metastasis after urologic oncology was reported in 1994 after a lymphadenectomy for transitional cell carcinoma. 2 In different studies, 13 cases of laparoscopic port site recurrence have been published after uro-oncologic surgery.…”

Section: Introductionmentioning

confidence: 99%