Introduction

Port site recurrence can be defined as subcutaneous tissue or abdominal wall malignant tumor reappearance following laparoscopy for malignancy, not associated with carcinomatosis at the time of the initial procedure.

The use of laparoscopy in the treatment of malignant disease has generated a great deal of controversy, in part, due to the fear of inadequate cancer control. The early laparoscopic experience cited in the surgical and gynecological literature initially elevated concerns regarding the risk of port site recurrence. Indeterminate surgical margins and loss of precise pathological staging information due to morcellation historically increased these concerns. In urologic surgery, minimally invasive procedures for malignant disease have shown equivalent cancer control when compared to traditional open approaches.

Recurrence of malignancy at trocar or port sites following laparoscopy has been described in the general surgical, gynecologic, and urologic literature.

Port site recurrence can be defined as subcutaneous tissue or abdominal wall malignant tumor reappearance following laparoscopy for malignancy, not associated with carcinomatosis at the time of the initial procedure.

To date, however, the majority of port site recurrences have been reported in the general and gynecologic surgical literature. From the early experience with laparoscopic cholecystectomy came reports of unrecognized gall bladder and gastrointestinal tumors recurring at the port sites following laparoscopy (1-6), which caused concern and criticisms of laparoscopy applied to oncologic surgery. As a result, some surgeons expressed the need for more formal prospective randomized studies to further understand this dilemma (7).

In an effort to retrospectively refute these criticisms, an initial broad survey of over 1050 European general surgery programs demonstrated port site recurrence in 17% of laparoscopic cholecystectomies where there was an incidental finding of gallbladder carcinoma and 4.6% of laparoscopic cases for colorectal cancer (8). The authors implicate laparoscopy as an independent factor leading to port site recurrence, without taking into account the incidental discovery of gastrointestinal cancer or unprotected organ removal from the abdomen, violating established cancer surgical principles. A six-year review of 533 procedures (mean follow-up of 13.2 months) from the University of Texas M.D. Anderson Cancer Center identified only four port site recurrences for nongynecologic laparoscopic cancer surgery. Three of the four patients had demonstrable intra-abdominal disease at the time of laparoscopy, with the final patient having the port site as the only site of recurrence. This group concluded that port site recurrence is not only rare, but also indeed more rare in those patients with no evidence of advanced intra-abdominal disease (9). The rarity of port site recurrence is further demonstrated in other contemporary series of laparoscopic oncologic procedures compared to open surgical experiences, with no statistically significant comparative wound recurrence rates (10-12).

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment