The true incidence of abdominal wall metastases after open or laparoscopic
operations is unknown. The large number of reports of patients with port si
te metastases may represent publication bias, but there is a suspicion that
recurrence of the tumour in the abdominal incision is more common after la
paroscopic operations. The aetiology of port site metastases is not known b
ut in cases of gallbladder cancer the laparoscopic handling of the tumour,
perforation of the gallbladder, and extraction of the malignant specimen ma
y be risk factors for the spread of malignant cells.
These risk factors are not equally applicable in laparoscopic colorectal ca
ncer operations in which the incidence of port site metastases seems to be
lower. In addition, several other factors are probably involved in the deve
lopment of such metastases, including the creation of pneumoperitoneum and
the use of different gases.
Laparoscopic cholecystectomy is contraindicated when gallbladder cancer is
known or suspected preoperatively. When signs of malignancy are encountered
during a laparoscopic operation it should be converted to an open procedur
e. If a gallbladder cancer is diagnosed after a completed laparoscopic oper
ation a careful clinical follow up is indicated and if signs of recurrent m
alignancy develop in the port sites they should be excised, particularly as
port site metastases may be the only manifestation of recurrent disease.