The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease

Medical Device Safety and Surgical Dissemination of Unrecognized Uterine Malignancy: Morcellation in Minimally Invasive Gynecologic Surgery

“…The majority of recurrences at port sites occur within a few months, but some have been reported as soon as 8 days and as late as 1 year after surgery [19][20][21]. The exact incidence of port-site metastasis in oncologic surgery is unknown but has been reported in retrospective reviews to be in the range of 0.24%-1.18%, rates similar to those of wound metastasis observed in patients undergoing laparotomy [22][23][24][25][26].…”

“…In a similar population selected to undergo laparoscopy prior to cytoreduction and neoadjuvant chemotherapy, 17% of patients with stage III or IV ovarian cancer developed port-site metastasis after diagnostic open laparoscopy, with no significant impact on survival [28]. Zivanovic et al found that 95% of patients with port-site recurrences had additional sites of recurrence and that time to recurrence was the sole predictor of survival [26]. The seminal study on laparoscopic surgical treatment in gynecologic oncology, the Gynecologic Oncology Group (GOG) LAP2 study, prospectively randomized women with clinical stage I endometrial cancer to comprehensive surgical staging by conventional laparotomy versus laparoscopy [22].…”

“…In contrast, isolated tumor seeding of trocar incisions is rare and does not alter overall survival when laparoscopy is performed for early stage disease such as endometrial or colon cancer [1,23,26].…”

Port-Site Metastasis Following Laparoscopic Surgery

“…H. Ng et al, 2009;S. M. Ng et al, 2008;Rassweiler et al, 2003;Shoup et al, 2002;Song et al, 2010;Zivanovic et al, 2008). In eight randomized clinical trials comparing laparoscopic surgery to open surgery for cancer, there was no statistical difference in the development of port-site metastasis or wound metastasis (COLOR, 2009;Fleshman et al, 2007;Jayne et al, 2010;Kaiser et al, 2004;Lacy et al, 2008;Liang et al, 2007;Lujan et al, 2009;S.…”

“…The rate at which port-site metastasis develop is likely a factor of the tumor biology. Zivanovic et al reported 20 of 1694 patients developing port-site metastasis after laparoscopic procedures for gynaecologic malignancies and showed that in patients who developed port-site metastasis 7 months from the laparoscopic procedure had a median survival of 12 months compared to 37 months for patients who develop port-site metastasis after 7 months (P=0.004) (Zivanovic et al, 2008). Therefore, port-site metastasis should be regarded a strong risk factor for peritoneal dissemination in addition to other previously described factors that include full thickness penetration of tumor through the bowel wall, spillage of tumor from lymphatic channels by surgical trauma or free perforation of the tumor (Sugarbaker, 1988).…”