Skip to main content

Advertisement

SpringerLink
Log in

Trocar site recurrence in laparoscopic surgery for colorectal cancer

Myth or real concern?

  • Original Articles
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic colorectal surgery has been associated with less postoperative pain, an early return of bowel function, a shorter period of hospitalization and disability, and better cosmetic results. However, the application of laparoscopic techniques to the curative resection of colorectal cancer is still controversial, owing to reports of cancer recurrence at the port site wounds. The accumulation of numerous such reports in a relatively short period raised concern that there might be an extraordinary high rate of port site metastases after laparoscopic colorectal surgery. This concern has led to intense clinical and basic research aimed at determining the incidence and causes of wound recurrence and developing preventative measures to address this problem. Despite these efforts, it is still not clear whether port site metastasis is really an inherent drawback to laparoscopic cancer surgery.

Methods

In this review of the literature on port site metastasis, we gathered data from clinical series of laparoscopic surgery for colorectal cancer. We eliminated series of <50 patients, since they may be flawed by the learning curve required for this technically demanding procedure.

Results

The rate of port site recurrences in the 1737 patients who participated in these series was 1%. Although the methods and criteria for patient selection in these studies varied, this figure appears to be comparable to the incidence reported for other malignancies and for laparotomies performed to treat colorectal cancer.

Conclusion

This review suggests that wound recurrence may actually be the result of an unfortunate learning curve, rather than an inherent concern. However, we must await the final results of large randomized studies before drawing any definitive conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alexander RJT, Jacques BC, Mitchell KG (1993) Laparoscopically assisted colectomy and wound recurrence [Letter]. Lancet 341: 249–250

    Article  PubMed  CAS  Google Scholar 

  2. Allardyce RA, Morreau P, Bagshaw PF (1997) Operative factors affecting tumor cell distribution following laparoscopic colectomy in a porcine model. Dis Colon Rectum 40: 939–945

    Article  PubMed  CAS  Google Scholar 

  3. Allardyce R, Morreau P, Bagshaw P (1996) Tumor cell distribution following laparoscopic colectomy in a porcine model. Dis Colon Rectum 39: S47-S52

    Article  PubMed  CAS  Google Scholar 

  4. American Society of Colorectal Surgeons Policy statement. Dis Colon Rectum 35: 5A

  5. Berends FJ, Kazemier G, Bonjer HJ, Lange JF (1994) Subcutaneous metastases after laparoscopic colectomy [Letter]. Lancet 334: 58

    Article  Google Scholar 

  6. Bouvet M, Mansfield PF, Skibber JM, Curley SA, Ellis LM, Giacco GG, Madary AR, Ota DM, Feig BW (1998) Clinical, pathologic, and economic parameters of laparoscopic colon resection. Am J Surg 176: 554–557

    Article  PubMed  CAS  Google Scholar 

  7. Bouvy ND, Marquet RL, Jeekel H, Banjer HJ (1996) Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastasis. Ann Surg 224: 694–701

    Article  PubMed  CAS  Google Scholar 

  8. Cirocco WC, Schwartzman A, Golub RW (1994) Abdominal wall recurrence after laparoscopic colectomy for colon cancer. Surgery 116: 842–846

    PubMed  CAS  Google Scholar 

  9. Cohen SM, Wexner SD (1993) Laparoscopic colorectal resection for cancer: the Cleveland Clinic Florida experience. Surg Oncol 2: 35S-42S

    Article  Google Scholar 

  10. Croce E, Azzola M, Russo R, Golia M, Olmi S (1997) Laparoscopic colectomy: the absolute need for a standard operative technique. J Soc Laparoendosc Surg 1: 217–224

    CAS  Google Scholar 

  11. Downey RJ, McCormack P, LoCicero III J (1996) Dissemination of malignant tumors after video-assisted thoracic surgery: a report of twenty-one cases. The Video-Assisted Thoracic Surgery Study Group. J Thorac Cardiovasc Surg 111: 954–960

    Article  PubMed  CAS  Google Scholar 

  12. Eshraghi N, Swanstrom LL, Bax T, Jobe B, Horvath K, Sheppard B, Deveney C (1999) Topical treatment of laparoscopic port site can decrease the incidence of incisional metastasis. Surg Endosc 13: 1121–1124

    Article  PubMed  CAS  Google Scholar 

  13. Fielding GA, Lumley J, Nathanson L, Hewitt P, Rhodes M, Stitz R (1997) Laparoscopic colectomy. Surg Endosc 11: 745–749

    Article  PubMed  CAS  Google Scholar 

  14. Fingerhut A (1995) Laparoscopic colectomy: the French experience. In: Jager R, Wexner SD (eds) Laparoscopic colorectal surgery. Churchill Livingstone. New York, pp

    Google Scholar 

  15. Fleshman JW, Nelson H, Peters WR, Kim HC, Larach S, Boorse RR, Ambroze W, Leggett P, Bleday R, Stryker S, Christenson E, Wexner S, Senagore A, Rattner D, Sutton-Fine AP (1996) Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 39: 53S-58S

    Article  Google Scholar 

  16. Franklin ME Jr, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A (1996) Prospective comparison of open vs. laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 39: 35S-46S

    Article  Google Scholar 

  17. Fusco MA, Paluzzi MW (1993) Abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarcinoma of the colon: report of a case. Dis Colon Rectum 36: 858–861

    Article  PubMed  CAS  Google Scholar 

  18. Gellman L, Salky B, Edye M (1996) Laparoscopic-assisted colectomy. Surg Endosc 10: 1041–1044

    Article  PubMed  CAS  Google Scholar 

  19. Goh YC, Eu KW, Seow Choen F (1997) Early postoperative results of a prospective series of laparoscopic versus open anterior resection for rectosigmoid cancer. Dis Colon Rectum 40: 776–780

    Article  PubMed  CAS  Google Scholar 

  20. Guillou PJ, Darzi A, Monson JR (1993) Experience with laparoscopic colorectal surgery for malignant disease. Surg Oncol 2, Suppl 1: 43–49

    Article  PubMed  Google Scholar 

  21. Gutt CN, Riemer V, Kim ZG, Jacobi CA, Paolucci V, Lorenz M (1999) Impact of laparoscopic colonic resection on tumor growth and spread in an experimental model. Br J Surg 86: 1180–1184

    Article  PubMed  CAS  Google Scholar 

  22. Hewett PJ, Texler ML, Anderson D, King G, Chatterton BE (1999) In vivo real-time analysis of intraperitoneal radiolabeled tumor cell movement during laparoscopy. Dis Colon Rectum 42: 868–875

    Article  PubMed  CAS  Google Scholar 

  23. Hewett PJ, Thomas WM, King G, Eaton M (1996) Intraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy. Dis Colon Rectum 39: 562–566

    Article  Google Scholar 

  24. Hsiu J, Given FT, Kemp GM (1986) Tumor implantation after diagnostic laparoscopic biopsy of serous ovarian tumors of low malignant potential. Obstet Gynecol 68: 90S-93S

    PubMed  CAS  Google Scholar 

  25. Hubens G, Pauwels M, Hubens A, Vermeulen P, Van Marck E, Eyskens E (1996) The influence of a pneumoperitoneum on the peritoneal implantation of free intraperitoneal colon cancer cells. Surg Endosc 10: 809–812

    Article  PubMed  CAS  Google Scholar 

  26. Hughes ES, McDermott FT, Polglase AL, Johnson WR, (1983) Tumor recurrence in the abdominal wall scare tissue after large bowel cancer surgery. Dis Colon Rectum 26: 571–572

    Article  PubMed  CAS  Google Scholar 

  27. Iwanaka T, Arya G, Ziegler MM (1998) Mechanism and prevention of port-site tumor recurrence after laparoscopy in a murine model. J Pediatr Surg 33: 457–461

    Article  PubMed  CAS  Google Scholar 

  28. Jacquet P, Averbach AM, Stephens AD, Sugarbaker PH (1995) Cancer recurrence following laparoscopic colectomy: report of two patients treated with heated intraperitoneal chemotherapy. Dis Colon Rectum 38: 1110–1114

    Article  PubMed  CAS  Google Scholar 

  29. Johnstone PA, Rohde DC, Swartz SE, Fetter JE, Wexner SD (1996) Port site recurrences after laparoscopic and thoracoscopic procedures in malignancy. J Clin Oncol 14: 1950–1956

    PubMed  CAS  Google Scholar 

  30. Jones DB, Guoe LW, Reinhard MK, Soper NJ, Philpott GW, Connett J, Fleshman JW (1995) Impact of pneumoperitoneum on trocar site implantation on colon cancer in hamster model. Dis Colon Rectum 38: 1182–1188

    Article  PubMed  CAS  Google Scholar 

  31. Jorgensen JO, McCall JL, Morris DL (1995) Port site seeding after laparoscopic ultrasonographic staging of pancreatic carcinoma [Letter]. Surgery 117: 118–119

    Article  PubMed  CAS  Google Scholar 

  32. Kadar N (1997) Port-site recurrence following laparoscopic operations for gynecological malignancies. Br J Obstet Gynecol 104: 1308–1313

    CAS  Google Scholar 

  33. Kawamura YJ, Sawada T, Sunami E, Saito Y, Watanabe T, Masaki T, Muto T (1999) Gasles laparoscopic-assisted colonic surgery. Am J Surg 177: 515–517

    Article  PubMed  CAS  Google Scholar 

  34. Khalili TM, Fleshner PR, Hiatt JR, Sokol TP, Manookian C, Tsushima G, Phillips EH (1998) Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 41: 832–838

    Article  PubMed  CAS  Google Scholar 

  35. Kwok SP, Lau WY, Carey PD, Kelly SB, Leung KL, Li AK (1996) Prospective evaluation of laparoscopic-assisted large bowel excision of cancer. Ann Surg 223: 170–176

    Article  PubMed  CAS  Google Scholar 

  36. Lacy AM, Garcia-Valdecasas JC, Delgado S, Grande L, Fuster J, Tabet J, Ramos C, Pique JM, Cifuentes A, Visa J (1997) Postoperative complications of laparoscopic-assisted colectomy. Surg Endosc 11: 119–122

    Article  PubMed  CAS  Google Scholar 

  37. Lane TM, Cook AJ (1999) Port site metastasis after laparoscopic cholecystectomy for benign disease. J Laparoendosc Adv Surg Tech A 9: 283–284

    Article  PubMed  CAS  Google Scholar 

  38. Larach SW, Patankar SK, Ferrara A, Williamson PR, Perozo SE, Lord AS (1997) Complications of laparoscopic colorectal surgery: analysis and comparison of early vs latter experience. Dis Colon Rectum 40: 592–596

    Article  PubMed  CAS  Google Scholar 

  39. Lauroy J, Champault G, Risk N (1994) Should digestive carcinoma still be managed by laparoscope? (Abstract) Br J Surg 81: 31s

  40. Lee SW, Gleason NR, Bessler M, Whelan RL (1999) Peritoneal irrigation with povidone-iodine solution after laparoscopic-assisted splenectomy significantly decreases port-tumor recurrence in a murine model. Dis Colon Rectum 42: 319–326

    Article  PubMed  CAS  Google Scholar 

  41. Lee SW, Southall J, Allendorf J, Bessler M, Whelan RL (1998) Traumatic handling of the tumor independent of pneumoperitoneum increases port site implantation rate of colon cancer in a murine model. Surg Endosc 12: 828–834

    Article  PubMed  CAS  Google Scholar 

  42. Leung KL, Yiu RY, Lai PB, Lee JF, Thung KH, Lau WY (1999) Laparoscopic-assisted resection of colorectal carcinoma: five-year audit. Dis Colon Rectum 42: 327–333

    Article  PubMed  CAS  Google Scholar 

  43. Lundberg O, Kristoffersson A (1999) Port site metastasis from gallbladder cancer after laparoscopic cholecystectomy: results of a Swedish survey and review of published reports. Eur J Surg 165: 215–222

    Article  PubMed  CAS  Google Scholar 

  44. Mathew G, Watson DI, Ellis T, De Young N, Rofe AM, Jamieson GG (1997) The effect of laparoscopy on the movement of tumor cells and metastases to surgical wounds. Surg Endosc 11: 1163–1166

    Article  PubMed  CAS  Google Scholar 

  45. Mathew G, Watson DI, Rofe AM, Baigrie CF, Ellis T, Jamieson GG (1996) Wound metastasis following laparoscopic and open surgery for abdominal cancer in a rat model. Br J Surg 83: 1087–1090

    Article  PubMed  CAS  Google Scholar 

  46. Mintz Y, Lotan C, Goitein D, Muggia-Sullan M, (1999) Laparoscopic port site metastasis of an undetected primary tumor. Surg Laparose Endosc 9: 68–69

    Article  CAS  Google Scholar 

  47. Montorsi M, Fumagailli U, Rosati R, Bond S, Chella B, Huscher C (1995) Early parietal recurrence of adenocarcinoma of the colon after laparoscopic colectomy. Br J Surg 82: 1036–1037

    Article  PubMed  CAS  Google Scholar 

  48. Nduka CC, Monson JR, Menzies-Gow N, Darzi A (1994) Abdominal wall metastases following laparoscopy. Br J Surg 81: 648–652

    Article  PubMed  CAS  Google Scholar 

  49. Nduka CC, Poland N, Kennedy M, Dye J, Darzi A (1998) Does the ultrasonically activated scalpel release viable airborne cancer cells? Surg Endosc 12: 1031–1034

    Article  PubMed  CAS  Google Scholar 

  50. Neuhaus SJ, Ellis T, Jamieson GG, Watson DI (1999) Experimental study of the effect of intraperitoneal heparin on tumor implantation following laparoscopy. Br J Surg 86: 400–404

    Article  PubMed  CAS  Google Scholar 

  51. Neuhaus SJ, Ellis T, Rofe AM, Pike GK, Jamieson GG, Watson DI (1998) Tumor implantation following laparoscopy using different insufflation gases. Surg Endosc 12: 1300–1302

    Article  PubMed  CAS  Google Scholar 

  52. Neuhaus SJ, Watson DI, Ellis T, Roie AM, Jamieson GG (1999) Influence of cytotoxic agents on intraperitoneal tumor implantation after laparoscopy. Dis Colon Rectum 42: 10–15

    Article  PubMed  CAS  Google Scholar 

  53. O’Rourke N, Price PM, Kelly S, Sikora K (1993) Tumor inoculation during laparoscopy [Letter]. Lancet 342: 368

    Article  PubMed  Google Scholar 

  54. Paik PS, Misawa T, Chiang M, Towson J, Im S, Ortega A, Beart RW Jr (1998) Abdominal incision tumor implantation following pneumoperitoneum: laparoscopic procedure versus standard open incision in a syngenic rat model. Dis Colon Rectum 41: 419–422

    Article  PubMed  CAS  Google Scholar 

  55. Poulin EC, Mamazza J, Schlachta CM, Gregoire R, Roy N (1999) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for adenocarcinoma. Ann Surg 229: 487–492

    Article  PubMed  CAS  Google Scholar 

  56. Prasad A, Avery C, Foley RJE (1994) Abdominal wall metastasis following laparoscopy [Letter]. Br J Surg 81: 1697

    Article  PubMed  CAS  Google Scholar 

  57. Ramos JM, Gupta S, Anthone GJ, Ortega AE, Simons AJ, Beart RW Jr (1994) Laparoscopy and colon cancer: is the port site at risk? a preliminary report. Arch Surg 129: 897–900

    PubMed  CAS  Google Scholar 

  58. Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O’Connell MJ (1996) Wound recurrence following conventional treatment of colorectal cancer: a rate but perhaps underestimated problem. Dis Colon Rectum 39: 200–207

    Article  PubMed  CAS  Google Scholar 

  59. Schiedeck TH, Schwandner O, Baca I, Baehrlehner E, Konradt J, Kockerling F, Kuthe A, Buerk C, Herold Bruch HP (2000) Laparoscopic surgery for the cure of colorectal cancer: results of a German five-center study. Dis Colon Rectum 43: 1–8

    Article  PubMed  CAS  Google Scholar 

  60. Schlinkert RT (1991) Laparoscopic-assisted hemicolectomy. Dis Colon Rectum 34: 1030–1031

    Article  PubMed  CAS  Google Scholar 

  61. Stocchi L, Nelson H (1998) Laparoscopic colectomy for colon cancer: trial update. J Surg Oncol 68: 255–267

    Article  PubMed  CAS  Google Scholar 

  62. Stockdale AD, Pocock TJ (1985) Abdominal wall metastases following laparoscopy: a case report. Eur J Surg Oncol 11: 373–375

    PubMed  CAS  Google Scholar 

  63. Tseng LN, Berends FI, Wittich P, Bouvy ND, Marquet RL, Kazenier G, Bonjer HJ (1998) Port-site metastases: impact of local tissue trauma and gas leakage. Surg Endosc 12: 1377–1380

    Article  PubMed  CAS  Google Scholar 

  64. Ugarte F (1995) Laparoscopic cholecystectomy port seeding from a colon carcinoma. Am Surg 61: 820–821

    PubMed  CAS  Google Scholar 

  65. Vukasin P, Ortega AE, Greene FL, Steele GD, Simons AJ, Anthone GJ, Weston LA, Beart RW Jr (1996) Wound recurrence following laparoscopic colon cancer resection. Dis Colon Rectum 39: 20S-23S

    Article  Google Scholar 

  66. Walsh DCA, Wattchow DA, Wilson TG (1993) Subcutaneous metastasis after laparoscopic resection of malignancy. Aust N Z J Surg 36: 563–565

    Article  Google Scholar 

  67. Watson DI, Mathew G, Ellis T, Baigrie CF, Rofe AM, Jamieson GG (1997) Gasless laparoscopy may reduce the risk of port site metastases following laparoscopic tumor surgery. Arch Surg 132: 166–169

    PubMed  CAS  Google Scholar 

  68. Whelan RL, Sellers GJ, Allendorf JD, Laird O, Bessler MD, Nowggrod R, Treat MR (1996) Trocar site recurrence is unlikely to result from aerosolization of tumor cells. Dis Colon Rectum 39: 7 (Suppl 10)-13S

  69. Winston CB, Chen JW, Fong Y, Schwartz LH, Panicek DM (1999) Recurrent gallbladder carcinoma along laparoscopic cholecystectomy port tracks: CT demonstration. Radiology 212: 439–444

    PubMed  CAS  Google Scholar 

  70. Wu JS, Bransfield EB, Guo LW, Ruiz M, Connett JM, Philpott GW, Jones DB, Fleshman JW (1997) Implantation of colon cancer at trocar sites is increased by low pressure pneumoperitoneum. Surgery 122: 1–7

    Article  PubMed  CAS  Google Scholar 

  71. Wu JS, Guo LW, Ruiz MB, Pfister SM, Connett JM, Fleshman JW (1998) Excision of trocar sites reduces tumor implantation in an animal model. Dis Colon Rectum 41: 1107–1111

    Article  PubMed  CAS  Google Scholar 

  72. Z’graggen K, Birrer S, Maurer CA, Wehrli H, Klaiber C, Baer HU (1998) Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery 124: 831–838

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, 33309, Fort Lauderdale, FL, USA

    O. Zmora, P. Gervaz & S. D. Wexner

Authors
  1. O. Zmora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Gervaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. D. Wexner
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Online publication: 12 June 2001

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zmora, O., Gervaz, P. & Wexner, S.D. Trocar site recurrence in laparoscopic surgery for colorectal cancer. Surg Endosc 15, 788–793 (2001). https://doi.org/10.1007/s004640080151

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s004640080151

Keywords

Search

Navigation