Abstract
Introduction
Port-site metastasis is an extremely rare event in patients with cancer treated with robotic-assisted surgery. However, as robotic procedures are increasing, the incidence of port-site metastases might also increase. The purpose of our review is to evaluate the up-to-now existing literature data on robotic port-site metastasis in the field of gynecological oncology.
Materials and methods
The authors retrieved the included results of the study after performing a systematic search in PubMed, Scopus, and Cochrane Library.
Results
In total, 20 patients were included in the study. The mean age of them was 56.3 (range 27–82) years. In the majority of the cases, endometrial cancer was responsible for port-site recurrences. The port-site metastasis occurred after 1–36 months postoperatively with the tumor measuring from 0.8 to 10.5 cm. As far as the management of this type of local recurrence, the most common therapeutic strategy adopted was the local excision followed by combined radiotherapy/chemotherapy.
Conclusions
Robotic surgery is a rather new technique and port-site metastasis is a rare complication of it. Due to this fact, we could not reach safe conclusions. The purpose of this study was to raise doctor’s clinical suspicion level to such a rare complication. Additional studies should be performed with the intention to clarify both port-site metastasis rates in gynecological oncology patients, as well as to elucidate the possible mechanisms of this type of local recurrence.
Similar content being viewed by others
References
Dobronte Z, Wittmann T, Karacsony G (1978) Rapid development of malignant metastases in the abdominal wall after laparoscopy. Endoscopy 10:127–130
Ramirez PT, Wolf JK, Levenback C (2003) Laparoscopic port-site metastases: etiology and prevention. Gynecol Oncol 91:179–189
Iavazzo C, Gkegkes ID (2013) Port site metastases after robot-assisted surgery: a systematic review. Int J Med Robot 9:423–427
Sert B (2010) Robotic port-site and pelvic recurrences after robot-assisted laparoscopic radical hysterectomy for a stage IB1 adenocarcinoma of the cervix with negative lymph nodes. Int J Med Robot 6:132–135
Lonnerfors C, Bossmar T, Persson J (2013) Port-site metastases following robot-assisted laparoscopic surgery for gynecological malignancies. Acta Obstet Gynecol Scand 92:1361–1368
Ndofor BT, Soliman PT, Schmeler KM, Nick AM, Frumovitz M, Ramirez PT (2011) Rate of port-site metastasis is uncommon in patients undergoing robotic surgery for gynecological malignancies. Int J Gynecol Cancer 21:936–940
Grabosch S, Xynos F (2013) Isolated port-site metastasis after robotic hysterectomy for stage IA endometrial adenocarcinoma. Obstet Gynecol 122:437–439
Kim B, Huh SJ, Kim BG (2013) Port site metastasis after robotic-assisted laparoscopic hysterectomy for uterine cervical cancer: a case report and literature review. Taiwan J Obstet Gynecol 52:558–563
Nguyen ML, Friedman J, Pradhan TS, Pua TL, Tedjarati SS (2013) Abdominal wall port site metastasis after robotically staged endometrial carcinoma: a case report. Int J Surg Case Rep 4:613–615
Rauff S, Ng JS (2012) Port-site recurrence in a patient undergoing robot-assisted gynecologic cancer surgery for endometrial cancer—a case report. Gynecol Oncol Case Rep 2:127–129
Rindos N, Curry CL, Tabbarah R, Wright V (2014) Port-site metastases after robotic surgery for gynecologic malignancy. JSLS 18:66–70
Bolles O, Borowsky M (2012) Port-site metastasis following robotic assisted radical hysterectomy for squamous cell cervical cancer. Gynecol Oncol Rep 2:32–34
Artola MCL, Salazar F, Gómez M, Molina JM, Cristóbal I (2014) Metástasis en el orificio del trocar en carcinoma de endometrio tras cirugía robótica: a propósito de un caso. Progresos de Obstetricia y Ginecología 57:185–190
Neuhaus SJ, Texler M, Hewett PJ, Watson DI (1998) Port-site metastases following laparoscopic surgery. Br J Surg 85:735–741
Rassweiler J, Tsivian A, Kumar AV et al (2003) Oncological safety of laparoscopic surgery for urological malignancy: experience with more than 1,000 operations. J Urol 169:2072–2075
Rane A, Eng MK, Keeley FX Jr (2008) Port site metastases. Curr Opin Urol 18:185–189
Highshaw RA, Vakar-Lopez F, Jonasch E, Yasko AW, Matin SF (2005) Port-site metastasis: the influence of biology. Eur Urol 47:357–360
Novitsky YW, Litwin DE, Callery MP (2004) The net immunologic advantage of laparoscopic surgery. Surg Endosc 18:1411–1419
Ost MC, Tan BJ, Lee BR (2005) Urological laparoscopy: basic physiological considerations and immunological consequences. J Urol 174:1183–1188
Jacobi CA, Wenger FA, Ordemann J, Gutt C, Sabat R, Muller JM (1998) Experimental study of the effect of intra-abdominal pressure during laparoscopy on tumour growth and port site metastasis. Br J Surg 85:1419–1422
Tseng LN, Berends FJ, Wittich P et al (1998) Port-site metastases. Impact of local tissue trauma and gas leakage. Surg Endosc 12:1377–1380
Kohlberger PD, Edwards L, Collins C, Milross C, Hacker NF (2000) Laparoscopic port-site recurrence following surgery for a stage IB squamous cell carcinoma of the cervix with negative lymph nodes. Gynecol Oncol 79:324–326
Curet MJ (2004) Port site metastases. Am J Surg 187:705–712
Zivanovic O, Sonoda Y, Diaz JP et al (2008) The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease. Gynecol Oncol 111:431–437
Pearlstone DB, Feig BW, Mansfield PF (1999) Port site recurrences after laparoscopy for malignant disease. Semin Surg Oncol 16:307–312
Martinez A, Querleu D, Leblanc E, Narducci F, Ferron G (2010) Low incidence of port-site metastases after laparoscopic staging of uterine cancer. Gynecol Oncol 118:145–150
Zhang Y, Luo X, Fan B, Chen H, Fu A, Huang J (2014) Effect of CO2 pneumoperitoneum on the proliferation of human ovarian cancer cell line SKOV-3 and the expression of NM23-H1 and MMP-2. Arch Gynecol Obstet. [Epub ahead of print]
Einarsson JI, Suzuki Y (2009) Total laparoscopic hysterectomy: 10 steps toward a successful procedure. Rev Obstet Gynecol 2:57–64
Conflict of interest
The authors have not any financial relationship/interest. Also, the authors have full control of all primary data and agree to allow the Journal to review their data if requested.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Iavazzo, C., Gkegkes, I.D. Port-site metastases in patients with gynecological cancer after robot-assisted operations. Arch Gynecol Obstet 292, 263–269 (2015). https://doi.org/10.1007/s00404-015-3658-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-015-3658-5