PORT SITE METASTASIS - AN UNRESOLVED PROBLEM IN LAPAROSCOPIC SURGERY - A REVIEW

After the explosive success of laparoscopic cholecystectomy, great int erest has been shown in the laparoscopic treatment of digestive malign ancies, Laparoscopy has been proposed for diagnosis and staging, and a s a technical option aiming to cure or palliate, But this optimism has been tempered by the doubt about the potential disseminatory role of laparoscopy after the observation of a large number of port site seedi ng tumors, Since the first laparoscopic cholecystectomy, more than 100 port site metastases have been reported, without a clear explanation for these findings, Port site recurrences have been observed after gyn aecologic procedures, laparoscopic cholecystectomy in which an unsuspe cted gallbladder cancer was found and after laparoscopic operations in dicated for oncological treatment of digestive tumors, mainly colorect al cancer, Other cases have been reported after thoracoscopic resectio n of oesophageal cancer or urologic cancer, even after staging laparos copy associated with sampling, Possible mechanisms for port site cell implantation are direct implantation in the wound during unprotected a nd forced tissue retrieval or by contaminated instruments during tumor dissection, the effect of gas turbulence in long laparoscopic procedu res and embolization of exfoliated cells during tumor dissection or he matogenous dissemination, Probably, a multifactorial mechanism may be responsible, in which the key factors could be a long operative proced ure, the high pressure pneumoperitoneum, tumoral manipulation during d issection and forced extraction of unprotected specimens, Prophylactic measures proposed to avoid this disastrous complication are the use o f protective bags for tissue retrieval, peritoneal lavage with heparin in order to avoid adhesion of free cells, or lavage with cytocidal so lutions.