Trocar metastases in laparoscopic approach for gynecologic malignancies. A short review of the literature

Introduction: Compared to laparotomy, laparoscopy has many benefits for patients, such as shorter recovery and lower morbidity rates. Port site metastases after laparoscopic approach in the treatment of gynecologic malignancies are uncommon. The purpose of this review is to identify and summarize possible risk factors for port-site metastases in patients undergoing laparoscopic surgery in the ambit of gynecologic oncology. Discussion: The precise incidence of port-site metastases is not well known because many patients are not followed-up during the whole postoperative period. Possible risk factors that can increase the risk of port-site metastases can be the presence of large masses in the abdomen, especially in the presence of concomitant ascites and in patients treated for ovarian carcinomas. Different theories have been postulated in order to explain the development of port site metastases during laparoscopy for oncological patients. Conclusions: Patient selection is an essential factor that can influence the incidence of port site metastases in gynecological patients. Robust data regarding port site metastases in gynecologic oncology are needed.

Laparoscopy; Port site metastases; Gynecologic oncology.

[1] Cho J.E., Nezhat F.R.: “Robotics and gynecologic oncology: review of the literature”. J. Minim. Invasive Gynecol., 2009, 16, 669.

[2] Dobronte Z., Wittmann T., Karacsony G.: “Rapid development of malignant metastases in the abdominal wall after laparoscopy”. Endoscopy, 1978, 10, 127.

[3] Kruitwagen R.F., Swinkels B.M., Keyser K.G., Doesburg W.H., Schijf C.P.: “Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer”. Gynecol. Oncol., 1996, 60, 233.

[4] Fusco M.A., Paluzzi M.W.: “Abdominal wall recurrence after laparoscopic- assisted colectomy for adenocarcinoma of the colon. Report of a case”. Dis. Colon Rectum, 1993, 36, 858.

[5] Ramirez P.T., Wolf J.K., Levenback C.: “Laparoscopic port-site metastases:etiology and prevention”. Gynecol. Oncol., 2003, 91, 179.

[6] Shoup M., Brennan M.F., Karpeh M.S., Gillern S.M., McMahon R.L., Conlon K.C.: “Port site metastasis after diagnostic laparoscopy for upper gastrointestinal tract malignancies: an uncommon entity”. Ann. Surg. Oncol., 2002, 9, 632.

[7] Copeland L.J., Saul P.B., Sneige N.: “Cervical adenocarcinoma tumor implantation in the episiotomy sites of two patients”. Gynecol. Oncol., 1987, 28, 230.

[8] Reymond M.A., Schneider C., Kastl S., Hohenberger W., Kockerling F.: “The pathogenesis of port-site recurrences”. J. Gastrointest. Surg., 1998, 2, 406.

[9] Wang P.H., Yuan C.C., Lin G., Ng H.T., Chao H.T.: “Risk factors contributing to early occurrence of port site metastases of laparoscopic surgery for malignancy”. Gynecol. Oncol., 1999, 72, 38.

[10] Kruitwagen R.F., Swinkels B.M., Keyser K.G., Doesburg W.H., Schijf C.P.: “Incidence and effect on survival of abdominal wallmetastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer”. Gynecol. Oncol., 1996, 60, 233.

[11] Hsiu J., Given F., Kemp G.: “Tumor implantation after diagnostic laparoscopic biopsy of serous ovarian tumors of low malignant potential”. Obstet. Gynecol., 1986, 68, 90.

[12] Gleeson N.C, Nicosia S.V, Mark J.E, Hoffman M.S, Cavanagh D.: “Abdominal wall metastases from ovarian cancer after laparoscopy”. Am. J. Obstet. Gynecol., 1993, 169, 522.

[13] Maimann M, Seltzer V, Boyce J.: “Laparoscopic excision of ovarian neoplasms subsequently found to be malignant”. Obstet. Gynaecol., 1991, 77, 563.

[14] Shepherd J.H, Carter P.G.: “Wound recurrence by implantation of a borderline ovarian tumor following laparoscopic removal”. Br. J. Obstet. Gynecol., 1994, 101, 265.

[15] Nduka C.C, Monson J.R.T, Menzies-Gow N, Darzi A.: “Abdominal wall metastases following laparoscopy”. Br. J. Surg., 1994, 81, 648.

[16] Pastner B., Damien M.: “Umbilical metastasis from a stage Ib cervical cancer after laparoscopy”. Fertil. Steril., 1992, 58, 1248.

[17] Kadar N.: “Port site recurrences following laparoscopic operations for gynecological malignancies”. Br. J. Obstet. Gynecol., 1997, 104, 1308.

[18] Lavie O., Cross P., Beller U., Dawlatly B., Lopes A., Monaghan J.M.: “Laparoscopic metastasis of an early adenocarcinoma of the cervix with negative lymph nodes”. Gynecol. Oncol., 1999, 75, 155.

[19] Wang P.H., Yen M.S., Yuan C.C., Chao K.C., Ng H.T., Lee W.L., Chao H.T.: “Port site metastasis after laparoscopic assisted vaginal hysterectomy for endometrial cancer: possible mechanisms and prevention”. Gynecol. Oncol., 1997, 66, 151.

[20] Muntz H.G., Goff B.A., Madsen B.L., Yon J.L.: “Port-site recurrence after laparoscopic surgery for endometrial carcinoma”. Obstet. Gynecol., 1999, 93, 807.

[21] Targarona E.M., Martinez J., Nadal A., Balague C., Cardesa A., Pascual S., Trias M.: “Cancer dissemination during laparoscopic surgery: tubes, gas and cells”. World J. Surg., 1998, 22, 55.

[22] Martinez J., Targarona E.M., Balague C., Pera M., Trias M.: “Port site metastasis. An unresolved problem in laparoscopic surgery: a review”. Int. Surg., 1995, 80, 315.

[23] Gutman M., Fidler I.J.: “Biology of human colon cancer metastasis”. World J. Surg., 1995, 19, 226.

[24] Neuhaus S.J., Ellis T., Rofe A.M., Pike G.K., Jamieson G.G., Watson D.I.: “Tumor implantation following laparoscopy using different insufflation gases”. Surg. Endosc., 1998, 12, 1300.

[25] Hewett P.J., Thomas W.M., King G., Eaton M.: “Intraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy: an in vivo model”. Dis. Colon Rectum, 1996, 39, S62.

[26] Bouvy N.D., Marquet R.L., Jeekel H., Bonjer H.J.: “Impact of gas (less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases”. Ann. Surg., 1996, 224, 694.

[27] Knolmayer T.J., Asbun H.J., Shibata G., Bowyer M.W.: “An experimental model of cellular aerosolization during laparoscopic surgery”. Surg. Laparosc. Endosc. Percutan. Tecn., 1997, 7, 339.

[28] Heel K.A., Hall J.C.: “Peritoneal defences and peritoneum-associated lymphoid tissue”. Br. J. Surg., 1996, 83, 1031.

[29] Bouvy N.D., Marquet R.L., Hamming J.F., Jeekel J., Bonjer H.J.: “Laparoscopic surgery in the rat: beneficial effect on body weightand tumor take”. Surg. Endosc., 1996, 10, 490.[30] Neuhaus S.J., Watson D.I., Ellis T., Rofe A.M., Jamieson G.G.: “The effect of immune enhancement and suppression on the developmentof laparoscopic port site metastases”. Surg. En dosc.2000, 14, 439.

[31] Cho J.M., LaPorta A.J., Clark J.R., Schofield M.J., Hammond S., Mallory P.L. II.: “Response of serum cytokines in patients undergoing laparoscopic cholecystectomy”. Surg. Endosc., 1994, 8, 1380.

[32] Kuntz C., Wunsch A., Bodeker C., Bay F., Rosch R., Windeler J., Herfarth C.: “Effect of pressure and gas type on intraabdominal subcutaneous and blood pH in laparoscopy”. Surg. Endosc., 2000, 14, 367.

[33] Agostini A., Robin F., Jais J.P., Aggerbeck M., Vilde F., Blanc B., et al.: “Peritoneal closure reduces port site metastases: results of an experiment in a rat ovarian cancer model”. Surg. Endosc., 2002, 16,289.

[34] Abulafia O., Triest W.E., Sherer D.M.: “Angiogenesis in malignanciesof the female genital tract”. Gynecol. Oncol., 1999, 72, 220.

[35] Wittich P., Mearadgi A., Marquet R.L., Bonjer H.J.: “Irrigation of port sites, prevention of port site metastases”. J. Laparoendosc. Adv. Surg., 2004, 14, 125.

[36] Pross M., Lipper H., Nestler G., Kuhn R., Langer H., Mantke R., Schulz H.U.: “Effect of low molecular weight heparin on intra-abdominalmetastasis in a laparoscopic experimental study”. Int. J. Colorectal Dis., 2004, 19, 143.

[37] Neuhaus S.J., Ellis T., Jamieson G.G., Watson D.I.: “Experimental study of the effect of intraperitoneal heparin on tumor implantation following laparoscopy”. Br. J. Surg., 1999, 86, 400.

[38] Van Dam P.A., DeCloedt J., Tjalma W.A., Buytaer P., Becquart D., Vergote I.B.: “Trocar implantation metastasis after laparoscopy in patients with advanced ovarian cancer: can the risk be reduced?” Am. J. Obstet. Gynecol., 1999, 181, 536.