Research Article: Port-Site Metastasis after Laparoscopic Surgery for Urological Malignancy: Forgotten or Missed

Date Published: April 10, 2012

Publisher: Hindawi Publishing Corporation

Author(s): N. Kadi, M. Isherwood, M. Al-Akraa, S. Williams.

http://doi.org/10.1155/2012/609531

Abstract

Purpose. Port-site metastasis has been a concern with the common use of laparoscopy in urologic oncology. We conducted this study to provide a review of port-site metastases reported after the laparoscopy in managing urologic malignancies, possible contributing factors and preventative measures. Materials and Methods. An electronic search of MEDLINE using the combined MESH key words “port-site metastasis” and “Urology”. Results. 51 articles addressing port-site metastasis after laparoscopic surgery for urolo¬gical malignancy were identified. Conclusion. Port-site metastasis after laparoscopic surgery for urolo¬gical malignancy is rare. The incidence is comparable to the rate for surgical wound metastases.

Partial Text

In recent years, with the widespread use of laparoscopy to treat an ever-increasing number of urologic malignancies, questions have been raised about the oncologic safety of this surgical approach [1]. Currently, a large number of specialized centres around the world perform laparoscopy for urologic cancer [2, 3]. Nevertheless, local recurrence and port-site metastasis remain a concern [4].

An electronic search of MEDLINE of the published literature up to 2010 was carried out using the combined MESH key words “port-site metastasis” and “Urology.”

Table 1 showed the case reports found on MEDLINE search of the published literature up to 2010 recovered 51 for the MESH words “port-site metastasis” and “Urology.”

Laparoscopic surgery is rapidly gaining widespread acceptance among urologists, including extensive application in malignant conditions [9]. The incidence of tumour seeding in general laparoscopic surgery ranges from 0.8% to 21% (8, 9). However, most authors report an incidence of 0.5%, comparable to the rate for surgical wound metastases (0.8%–1.6%) in conventional open methods [9–11]. In recent years, several reports of port-site metastasis and tumor seeding have been published. Tsivian and Sidi [9] alone reported nine cases of port-site metastases after urologic laparoscopy, and Rassweiler and colleagues [10] published eight local recurrences observed in 1098 laparoscopic procedures for urologic malignancies. Recently, in an international survey of 19 urologic laparoscopic centres performing a total of 18,750 laparoscopic procedures for urologic malignancies, tumour seeding was reported in 13 cases (0.1%) [8].

Port-site metastasis in urological laparoscopic surgery is rare. Multiple factors have been associated with tumour seeding, but tumour grade and stage appear to play a major role. Multiple methods have been described to reduce the risk of port-site metastasis. The incidence is comparable to the rate for surgical wound metastases.

 

Source:

http://doi.org/10.1155/2012/609531

 

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