ABDOMINAL-WALL TUMOR IMPLANTATION AFTER LAPAROSCOPY FOR MALIGNANT CONDITIONS

Objective: To determine the incidence of abdominal-wall tumor implanta tion after laparoscopic procedures in patients with known malignancies . Methods: We reviewed 557 laparoscopic procedures performed by the Gy necologic Oncology Service between November 1990 and February 1994. In 105 procedures, malignancy was documented cytologically or histologic ally, 88 with intraperitoneal disease and 17 with retroperitoneal dise ase. Ovarian cancer represented 80% (70 of 88) of the procedures with intraperitoneal malignancy, and the remaining eases consisted of carci noma of the fallopian tube (two), endometrium (11), cervix (one), brea st (three), and stomach lone). Histologically, ovarian carcinomas rang ed from low malignant potential to poorly differentiated. Among 88 pat ients with intraperitoneal disease, 77 had gross disease and 11 had mi croscopic disease. Four hundred thirty-seven different abdominal-wall puncture sites were used (38 Veress needle sites and 399 laparoscopic ports). Results: One of the 437 (0.2%) abdominal-wall puncture sites d eveloped implantation, a frequency of 1.0% (one in 105) per procedure; this developed after a second-look laparoscopic procedure for ovarian carcinoma in which only microscopic disease was present. If only intr aperitoneal disease is considered, the incidence of implantation was 0 .3% (one in 363) per abdominal puncture and 1.1% (one in 88) per proce dure. Conclusion: Tumor implantation at the abdominal-wall puncture si te is an infrequent occurrence after laparoscopy in patients with intr aperitoneal and retroperitoneal carcinoma.