Trocar implantation metastasis after laparoscopy in patients with advancedovarian cancer: Can the risk be reduced?

OBJECTIVE: The purpose of this study was to determine risk factors for troc ar implantation metastasis after diagnostic laparoscopy in patients with pr imary or recurrent advanced ovarian cancer. STUDY DESIGN: Eighty-three women with primary advanced ovarian cancer and 2 1 women with recurrent ovarian cancer undergoing a laparoscopy for a tissue diagnosis and for assessment of operability were included in the study. Th e occurrence of implantation metastasis at the trocar incision scars was an alyzed according to clinicopathologic characteristics. RESULTS: A recurrence developed at the trocar site in 7 (58%) of 12 patient s undergoing a laparoscopy in which only the skin was closed at the end of the procedure and in 2 (2%) of 92 patients undergoing a laparoscopy with cl osure of all layers (odds ratio, 63; 95% confidence interval, 10.3-385; P < .001). The International Federation of Gynecology and Obstetrics stage at i nitial presentation, tumor histologic type, tumor differentiation, maximal tumor diameter at the time of diagnosis, estimated weight of the metastatic tumor, residual tumor after cytoreductive surgery, surgical characteristic s, and type of chemotherapy were well balanced among both groups. Patients with implantation metastasis had significantly more ascites (median, 700 mt vs 300 mt; P=.032) and a longer interval between the start of platinum-bas ed chemotherapy or cytoreductive surgery (median, 6 days vs 17 days; P<.01) compared with patients without abdominal wall recurrence. A palpable abdom inal wall metastasis developed in none of the patients undergoing a laparos copy with closure of all layers of the abdomen followed by cytoreductive su rgery or chemotherapy within 1 week after the laparoscopy. Kaplan-Meier sur vival analysis showed that patients with abdominal wall implantation metast asis had a survival rate similar to that of the other patients. CONCLUSIONS: Laparoscopy with careful closure of the peritoneum, rectus she ath, and skin followed by chemotherapy or cytoreductive surgery with excisi on of the trocar trajectories within 1 week is safe in patients with dissem inated ovarian cancer.