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Port-Site Metastases is an Independent Prognostic Factor in Patients with Peritoneal Carcinomatosis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Port-site metastases (PSMs) have been reported after laparoscopy in patients with peritoneal carcinomatosis (PC). We hypothesize that PSM is an independent negative predicting factor of survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).

Methods

A retrospective review of a prospective database was conducted to search patients who underwent laparoscopy prior to CRS/HIPEC. Most of the tumors were of appendiceal origin. All previous laparoscopy port sites were excised regardless of macroscopic tumor involvement. Patients were divided into two groups: patients with PSM [PSM (+)] and patients without PSM [PSM (−)]. Overall survival (OS) was estimated by Kaplan–Meier curves and the log-rank test. Cox regression [hazard ratios (HRs) and 95 % confidence intervals (CIs)] was used to test for independent effects of the PSM (+) and the associated clinicopathological variables.

Results

Sixty-five patients had laparoscopy before CRS/HIPEC. One hundred and forty-four port-sites were resected; 41 (29 %) ports were positive for malignancy in a total of 22 (34 %) patients. Mean OS at 1, 3, and 5 years was 88, 66, and 63 %, respectively. Survival in patients with PSM was 73, 35, and 23 %, respectively, compared with 95, 82, and 82 %, respectively, in patients without PSM (p ≤ 0.001). Positive lymph nodes (LNs) were detected in 13/22 patients with PSM and 11/43 patients without PSM. Independent effects on survival shows an HR of 3.136, 95 % CI 1.150–8.549 (p = 0.026) for LN metastases, and an HR of 3.462, 95 % CI 1.198–10.006 (p = 0.022) in patients with positive PSM.

Conclusion

PSMs are common in patients with PC undergoing CRS/HIPEC and are independently associated with a worse prognosis. Resection of previous laparoscopy port sites is advocated in patients with PC to ensure complete cytoreduction.

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References

  1. Elias D, Goere D, Dumont F, et al. Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases. Eur J Cancer. 2014;50(2):332–340.

    Article  CAS  PubMed  Google Scholar 

  2. Elias DM, Ouellet JF. Intraperitoneal chemohyperthermia: rationale, technique, indications, and results. Surg Oncol Clin N Am. 2001;10(4):915–933, xi.

    CAS  PubMed  Google Scholar 

  3. Sommariva A, Pilati P, Rossi CR. Cyto-reductive surgery combined with hyperthermic intra-peritoneal chemotherapy for peritoneal surface malignancies: current treatment and results. Cancer Treat Rev. 2012;38(4):258–268.

    Article  PubMed  Google Scholar 

  4. Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7(1):69–76.

    Article  PubMed  Google Scholar 

  5. Chua TC, Moran BJ, Sugarbaker PH, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–2456.

    Article  PubMed  Google Scholar 

  6. Esquivel J, Elias D, Baratti D, Kusamura S, Deraco M. Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol. 2008;98(4):263–267.

    Article  PubMed  Google Scholar 

  7. Omohwo C, Nieroda CA, Studeman KD, et al. Complete cytoreduction offers longterm survival in patients with peritoneal carcinomatosis from appendiceal tumors of unfavorable histology. J Am Coll Surg. 2009;209(3):308–312.

    Article  PubMed  Google Scholar 

  8. Laterza B, Kusamura S, Baratti D, Oliva GD, Deraco M. Role of explorative laparoscopy to evaluate optimal candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal mesothelioma. In Vivo. 2009;23(1):187–190.

    Google Scholar 

  9. Valle M, Federici O, Garofalo A. Patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, and role of laparoscopy in diagnosis, staging, and treatment. Surg Oncol Clin N Am. 2012;21(4):515–531.

    Article  PubMed  Google Scholar 

  10. Ouellette JR, Ko AS, Lefor AT. The physiologic effects of laparoscopy: applications in oncology. Cancer J. 2005;11(1):2–9.

    Article  PubMed  Google Scholar 

  11. Curet MJ. Port site metastases. Am J Surg. 2004;187(6):705–712.

    Article  PubMed  Google Scholar 

  12. Ziprin P, Ridgway PF, Peck DH, Darzi AW. The theories and realities of port-site metastases: a critical appraisal. J Am Coll Surg. 2002;195(3):395–408.

    Article  PubMed  Google Scholar 

  13. Chua TC, Yan TD, Morris D, Sugarbaker PH. Port-site metastasis following laparoscopic surgery. Adv Laparosc. 2011.

  14. Ramirez PT, Wolf JK, Levenback C. Laparoscopic port-site metastases: etiology and prevention. Gynecol Oncol. 2003;91(1):179–189.

    Article  PubMed  Google Scholar 

  15. Shoup M, Brennan MF, Karpeh MS, Gillern SM, McMahon RL, Conlon KC. Port site metastasis after diagnostic laparoscopy for upper gastrointestinal tract malignancies: an uncommon entity. Ann Surg Oncol. 2002;9(7):632–636.

    Article  PubMed  Google Scholar 

  16. Velanovich V. The effects of staging laparoscopy on trocar site and peritoneal recurrence of pancreatic cancer. Surg Endosc. 2004;18(2):310–313.

    Article  CAS  PubMed  Google Scholar 

  17. Dijkum V, Nieveen EJ, de Wit LT, Obertop H, Gouma DJ. Port-site metastases following diagnostic laparoscopy. Br J Surg. 1996;83(12):1793–1794.

    Article  Google Scholar 

  18. El Halabi H, Gushchin V, Francis J, et al. The role of cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) in patients with high-grade appendiceal carcinoma and extensive peritoneal carcinomatosis. Ann Surg Oncol. 2012;19(1):110–114.

    Article  PubMed  Google Scholar 

  19. Sugarbaker PH. Peritonectomy procedures. Surg Oncol Clin N Am. 2003;12(3):703–727, xiii.

    Article  PubMed  Google Scholar 

  20. Zivanovic O, Sonoda Y, Diaz JP, et al. The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease. Gynecol Oncol. 2008;111(3):431–437.

    Article  PubMed  Google Scholar 

  21. Zmora O, Weiss EG. Trocar site recurrence in laparoscopic surgery for colorectal cancer. Myth or real concern? Surg Oncol Clin N Am. 2001;10(3):625–638.

    CAS  PubMed  Google Scholar 

  22. Garofalo A, Valle M. Laparoscopy in the management of peritoneal carcinomatosis. Cancer J. 2009;15(3):190–195.

    Article  PubMed  Google Scholar 

  23. Neuhaus SJ, Texler M, Hewett PJ, Watson DI. Port-site metastases following laparoscopic surgery. Br J Surg. 1998;85(6):735–741.

    Article  CAS  PubMed  Google Scholar 

  24. Schaeff B, Paolucci V, Thomopoulos J. Port site recurrences after laparoscopic surgery: a review. Dig Surg. 1998;15(2):124–134.

    Article  CAS  PubMed  Google Scholar 

  25. Rao S, Rathod A, Kamble AT, Gupta D. Delayed presentation of port-site metastasis from an unknown gastrointestinal malignancy following laparoscopic cholecystectomy. Singapore Med J. 2014;55(5):e73–76.

    Article  PubMed  Google Scholar 

  26. Sommariva A, Zagonel V, Rossi CR. The role of laparoscopy in peritoneal surface malignancies selected for hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2012;19(12):3737–3744.

    Article  PubMed  Google Scholar 

  27. Halabi HE, Gushchin V, Francis J, et al. Prognostic significance of lymph node metastases in patients with high-grade appendiceal cancer. Ann Surg Oncol. 2012;19(1):122–125.

    Article  PubMed  Google Scholar 

  28. Van Sweringen HL, Hanseman DJ, Ahmad SA, Edwards MJ, Sussman JJ. Predictors of survival in patients with high-grade peritoneal metastases undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Surgery. 2012;152(4):617–624.

    Article  PubMed  Google Scholar 

  29. Maker AV, Butte JM, Oxenberg J, et al. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol. 2012;19(2):409–417.

    Article  PubMed  Google Scholar 

  30. Wu JS, Guo LW, Ruiz MB, Pfister SM, Connett JM, Fleshman JW. Excision of trocar sites reduces tumor implantation in an animal model. Dis Colon Rectum. 1998;41(9):1107–1111.

    Article  CAS  PubMed  Google Scholar 

  31. Muntean V, Oniu T, Lungoci C, et al. Staging laparoscopy in digestive cancers. J Gastrointestin Liver Dis. 2009;18(4):461–467.

    PubMed  Google Scholar 

  32. Pomel C, Appleyard TL, Gouy S, Rouzier R, Elias D. The role of laparoscopy to evaluate candidates for complete cytoreduction of peritoneal carcinomatosis and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2005;31(5):540–543.

    Article  CAS  PubMed  Google Scholar 

  33. Valle M, Garofalo A. Laparoscopic staging of peritoneal surface malignancies. Eur J Surg Oncol. 2006;32(6):625–627.

    Article  PubMed  Google Scholar 

  34. Iversen LH, Rasmussen PC, Laurberg S. Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Br J Surg. 2013;100(2):285–292.

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Maria F. Nunez, Armando Sardi, William Jimenez, Carol Nieroda, Michelle Sittig, Ryan MacDonald, Nail Aydin, Vladimir Milovanov, and Vadim Gushchin declare that there are no financial or commercial interests in the present study.

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Authors and Affiliations

  1. Institute for Cancer Care at Mercy Medical Center, Baltimore, MD, USA

    Maria F. Nunez MD, Armando Sardi MD, FACS, William Jimenez MD, Carol Nieroda MD, Michelle Sittig RN, Ryan MacDonald PhD, Nail Aydin MD, Vladimir Milovanov MD & Vadim Gushchin MD, FACS

Authors
  1. Maria F. Nunez MD
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  2. Armando Sardi MD, FACS
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  3. William Jimenez MD
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  4. Carol Nieroda MD
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  5. Michelle Sittig RN
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  6. Ryan MacDonald PhD
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  7. Nail Aydin MD
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  8. Vladimir Milovanov MD
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  9. Vadim Gushchin MD, FACS
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Correspondence to Armando Sardi MD, FACS.

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Nunez, M.F., Sardi, A., Jimenez, W. et al. Port-Site Metastases is an Independent Prognostic Factor in Patients with Peritoneal Carcinomatosis. Ann Surg Oncol 22, 1267–1273 (2015). https://doi.org/10.1245/s10434-014-4136-1

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  • DOI: https://doi.org/10.1245/s10434-014-4136-1

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