Tumor Seeding following Laparoscopy: International Survey

Abstract

The aim of the study was to determine if tumor seeding during laparoscopic surgery for cancer is a rare event or a typical complication of this procedure. Laparoscopic staging and treatment of intraabdominal tumors is increasing in gastroenterology, gynecology, and general surgery. A total of 1052 questionnaires were mailed to surgical department chairmen, members of the German Society of Surgery, Swiss Association for Laparoscopic and Thoracoscopic Surgery, and Austrian Society of Minimal Invasive Surgery asking them to list their department's experience with tumor seeding after laparoscopy for nonapparent or known malignancy. There were 607 (57.7%) surgeons who reported a total of 117,840 laparoscopic cholecystectomies, 409 incidental gallbladder carcinomas, and 412 laparoscopies on patients with colorectal carcinoma. Altogether 109 patients who developed tumor recurrence in connection with laparoscopic surgery have been reported. Port-site recurrence was identified in 70 of 409 patients (17.1%) with a median of 180 days following laparoscopic cholecystectomy for nonapparent gallbladder carcinoma. In 8 cases (11.5%) a protective plastic bag had been used for gallbladder retrieval. Six patients without port-site metastases were found to have a diffuse peritoneal carcinomatosis a median of 120 days after cholecystectomy. Of 412 laparoscopies for colorectal cancer, 19 cases (4.6%) of tumor seeding have been reported, 16 of which (3.9%) had documented port-site and scar recurrences a median of 196 days after laparoscopy. The tumor specimen was intact, and a plastic bag was used for extraction in seven cases. In 14 patients trocar-site metastases have been reported a median of 70 days after laparoscopy for different nonapparent or known malignancies. The probability of developing abdominal wall metastasis is higher after laparoscopy for cancer than after open surgery. An intact surgical specimen and the use of a plastic retrieval bag do not exclude the risk of port-site recurrences. These facts and the early appearance of peritoneal carcinosis in a few cases of intraabdominal malignancies seem to confirm a specific laparoscopic risk for intraperitoneal tumor cell seeding and implantation.

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…However, LC may increase the risk of port site recurrence and peritoneal dissemination as a result of bile leak associated with gallbladder injury [159][160][161]. In patients with incidental gallbladder carcinoma, which is found after cholecystectomy, the ratio of port site recurrence or peritoneal dissemination is reported relatively high with 10-18% and the period until recurrence is relatively short with 6-10 months [162][163][164][165][166][167][168][169][170].…”

Laparoscopic versus open resection for appendix carcinoid

“…Recent data indicate that laparoscopy cancer resection does not increase the risk of local recurrence or wound metastasis compared to that associated with open surgery [4,11,17]. However, Paolucci et al [18] observed high rates of abdominal wall metastases (port site metastases) after the laparoscopic resection of occult gallbladder carcinoma. These data on occult cancer are of particular relevance to the role of laparoscopic surgery for appendix neoplasms, which are nearly always resected as occult tumors.…”

Dynamic ultrasound with postural change facilitated the detection of an incisional hernia in a case with negative MRI findings

“…Oral intake of contrast and the use of Valsava maneuver are recommended to increase the diagnostic accuracy [2]. Furthermore, in such a case with intraabdominal malignancy, tumor seeding along the trocar tract should be always kept in the differential diagnosis [8], which can be well delineated by both imaging tools. Another potential causes comprised a post-surgical seroma or hematoma, which corresponded the characteristics of the present tumor with the size varying according to different postures.…”