PORT SITE RECURRENCES AFTER LAPAROSCOPIC SURGERY - A REVIEW

Port site metastasis has been a surprising event after laparoscopic pr ocedures in cancer patients. No clear data exist about this phenomenon . The aim of this study is to summarize current epidemiologic knowledg e about the risk of this complication. A review of all case reports ab out port site recurrences was undertaken. To date, 164 cases of port s ite metastases after videoscopic procedures have been reported in 90 p apers. We found 108 cases of implantation after laparoscopy for digest ive tumors, 23 after thoracoscopy, 29 after gynecological and 4 after urological laparoscopy. Analysis of the current literature confirms th at laparoscopy is associated with abdominal cell mobilization to the t rocars and instruments. Also low-staged and highly differentiated tumo rs have been reported to cause post-laparoscopy tumor seeding. The tem porary data of the CAE registry 'port site metastases' (Workgroup for Surgical Endoscopy of the German Society of Surgery) are also reported . The analysis of XO histologically confirmed cases of port site recur rence shows a particular frequency after Laparoscopic cholecystectomy for unsuspected gallbladder cancer (n = 59). Postoperative specimen ex amination revealed a T1 carcinoma in 9 cases (15%), T2 carcinoma in 33 (21%), T3 in 3 (5%) and T4 in 1 case (1.7%). The mean time to clinica l tumor relapse was 6 months. Similar patterns were found in a lower n umber of port site metastases after laparoscopy for colon cancer (n = 2) and for other cancers (n = 9). Clinical evidence that laparoscopy w ith CO2 pneumoperitoneum can enhance tumor dissemination is given. Por e site metastases seem to be secondary to multiple factors including t he gas used, local trauma, tumor manipulation, biologic properties of the tumor, and individual surgical skills.