PORT SITE METASTASIS AFTER LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMYFOR ENDOMETRIAL CANCER - POSSIBLE MECHANISMS AND PREVENTION

Only 19 cases of metastases at the cannula insertion site after laparo scopy for gynecological malignancy have been reported in the literatur e. One case has been diagnosed with cervical squamous cell carcinoma, whereas the others have been diagnosed with ovarian cancer and borderl ine ovarian tumor. We present a novel case of laparoscopy-site abdomin al wall metastasis from endometrial cancer after laparoscopic-assisted vaginal hysterectomy (LAVH). The 56-year-old female patient exhibited metastases of an abdominal wall trocar site and a perineal site after undergoing LAVH and laparoscopic-assisted (LA) bilateral pelvic lymph node sampling as well as LA para-aortic lymph node sampling for treat ing endometrial carcinoma, surgical staging IIIC, G3. The interval bet ween the surgical extirpation of endometrial carcinoma and diagnosis o f the tumor recurrence was 6 months, suggesting that overmanipulation of the diseased organ during laparoscopic surgery may have resulted in tumor spillage, intraperitoneal dissemination, and wound contaminatio n. Although this procedure has been proven beneficial to patients with benign disease or early-stage gynecologic malignancies, laparoscopic- assisted vaginal hysterectomy may not be efficacious to eradicate adva nced gynecological malignancy. (C) 1997 Academic Press.