Abstract
The purpose of this study was to evaluate the incidence and characteristics of patients with port-site metastasis following robotic assisted surgery for gynecological malignancies. Patients who underwent robotic assisted total laparoscopic hysterectomy and surgical staging at a single institution from November 2006 through November 2011 were retrospectively identified. Medical records were reviewed and the following information was extracted: diagnosis, histology, tumor extension, procedure, complications and post-surgical intervention. Port-site metastases were differentiated between isolated and not isolated. All metastases were confirmed with biopsy and treated with chemotherapy and radiotherapy as indicated. Four hundred forty-six patients with endometrial carcinoma were identified who had undergone robotic assisted hysterectomy and staging. Eight patients were converted to laparotomy and excluded from the study. Of 438 patients, 384 patients were diagnosed with early stages (stages 1 and 2), and 54 were diagnosed with advanced stages (stages 3 and 4). A total of 332 patients underwent pelvic lymphadenectomy regardless of the endometrial cancer stage; of those, 283 with early stage disease underwent pelvic lymphadenectomy, while 49 with advanced stage disease underwent pelvic lymphadenectomy. One hundred seventy-six patients received adjuvant treatment after surgical staging. Four patients were identified with port-site metastases (0.9 %), two patients were reported as isolated metastases. The mean patient age was 63 and mean BMI was 37 kg/m2. The incidence of port-site metastasis is low after robotic assisted surgery for treatment of endometrial cancer (0.9 %). There is no clear risk factor for development of port-site metastasis or easily identifiable prevention.
References
Chapron C, Fauconnier A, Goffinet F, Bréart G, Dubuisson JB (2002) Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod 17(5):1334
Chi DS, Abu-Rustum NR, Sonoda Y, Awtrey C, Hummer A, Venkatraman ES, Franklin CC, Hamilton F, Gemignani ML, Barakat RR (2004) Ten-year experience with laparoscopy on a gynecologic oncology service: analysis of risk factors for complications and conversion to laparotomy. Am J Obstet Gynecol 191(4):1138
Dobronte Z, Wittmann T, Karacsony G (1978) Rapid development of malignant metastases in the abdominal wall after laparoscopy. Endoscopy 10:127–130
Martınez A, Querleu D, Leblanc E et al (2010) Low incidence of port-site metastases after laparoscopic staging of uterine cancer. Gynecol Oncol 118:145–150
Van Dam PA, DeCloedt J, Tjalma WA et al (1999) Trocar implantation metastasis after laparoscopy in patients with advanced ovarian cancer: can the risk be reduced? Am J Obstet Gynecol 181:536–541
Wang PH, Yen MS, Yuan CC et al (1997) Port site metastasis after laparoscopic-assisted vaginal hysterectomy for endometrial cancer: possible mechanisms and prevention. Gynecol Oncol 66:151–155
Zivanovic O, Sonoda Y, Diaz JP et al (2008) The rate of port-site metastasis after 2251 laparoscopic procedures in women with underlying malignant disease. Gynecol Oncol 111:431–437
Song JB, Tanagho YS, Kim EH, Abbosh PH, Vemana G, Figenshau RS (2013) Camera-port site metastasis of a renal-cell carcinoma after robot-assisted partial nephrectomy. J Endourol 27(6):732–739
Childers JM, Aqua KA, Surwit EA et al (1994) Abdominal-wall tumor implantation after laparoscopy for malignant conditions. Obstet Gynecol 84:765–769
Ramirez PT, Frumovitz M, Wolf JK, Levenback C (2004) Laparoscopic port-site metastases in patients with gynecological malignancies. Int J Gynecol Cancer 14:1070–1077
Reymond MA, Schneider C, Kastl S et al (1998) The pathogenesis of port-site recurrences. J Gastrointest Surg 2:406–414
Gupta A, Watson DI, Ellis T, Jamieson GG (2002) Tumor implantation following laparoscopy using different insufflation gases. Aust NZJ Surg 72:254–257
Bih T, Ndofor MD, Pamela T, Soliman MD, Kathleen M, Schmeler MD, Alpa M, Nick MD, Michael Frumovitz MD, Pedro T, Ramirez MD (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
Lönnerfors C, Bossmar T, Persson J (2013) Port-site metastases following robot-assisted laparoscopic surgery for gynecological malignancies. Acta Obstet Gynecol Scand 92:1361–1368
Iavazzo C, Gkegkes ID (2013) Port site metastases after robot-assisted surgery: a systematic review. Int J Med Robot 9(4):423–427
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
Jones DB, Guo LW, Reinhard MK et al (1995) Impact of pneumoperitoneum on trocar site implantation of colon cancer in hamster model. Dis Colon Rectum 38:1182–1188
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
Hubens G, Pauwels S, Eyskens E (1997) Data presented at the first workshop on experimental laparoscopic surgery. Frankfurt, Germany, pp 9–10
Jacobi CA, Sabat R, BÖhm B et al (1997) Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells. Surgery 121:72–78
Jacobi CA, Wenger FA, Ordemann J et al (1998) Experimental study of the effect of intra-abdominal pressure during laparoscopy on tumor growth and port site metastasis. Br J Surg 85:1419–1422
Minardi D, Lucarini G, Mazzucchelli R et al (2005) Prognostic role of Fuhrman grade and vascular endothelial growth factor in pT1a clear cell carcinoma in partial nephrectomy specimens. J Urol 174:1208–1212
Stephenson AJ, Chetner MP, Rourke K et al (2004) Guidelines for the surveillance of localized renal cell carcinoma based on the patters of relapse after nephrectomy. J Uroltruma 172:58–62
Hewett PJ, Thomas WM, King G, Eaton M (1996) Intraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy. An in vivo model. Dis Colon Rectum 39:S62–S66
Stolla V, Rossi D, Bladou F et al (1994) Subcutaneous metastases after coelioscopic lymphadenectomy for vesical urothelial carcinoma. Eur Urol 26:342–343
Gutt CN, Riemer V, Kim ZG et al (1999) Impact of laparoscopic colonic resection on tumour growth and spread in an experimental model. Br J Surg 86:1180–1184
Kadar N (1997) Port-site recurrences following laparoscopic operations for gynaecological malignancies. Br J Obstet Gynaecol 104:1308–1313
Ramshaw BJ (1997) Laparoscopic surgery for cancer patients. CA Cancer J Clin 47:327–350
Allardyce RA (1999) Is the port site really at risk? Biology, mechanisms and prevention: a critical view. Aust N Z J Surg 69:479–485
Conflict of interest
D. Barraez, H. Godoy, T. McElrath, D. Kredentser, P. Timmins certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Consent section
Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Ethical statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. For this retrospective study a formal consent was not required.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barraez, D., Godoy, H., McElrath, T. et al. Low incidence of port-site metastasis after robotic assisted surgery for endometrial cancer staging: descriptive analysis. J Robotic Surg 9, 91–95 (2015). https://doi.org/10.1007/s11701-014-0491-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-014-0491-y