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 [
Port-site metastases, though rare, have been extensively documented for other gynaecological and GI malignancies. When they occur, they often do so in the presence of advanced disease, but it is not uncommon for them to occur in isolation [
The first known report of a port-site metastasis was by Dobronte and associates [
Port-site metastases is a multifactorial phenomenon with an as-yet undetermined incidence. Etiological factors include natural malignant disease behavior [
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.”
Duplicate references, as well as repeated references to the same data sets, were removed. The articles and case reports directly addressing port-site metastasis after laparoscopic surgery for urological malignancy were reviewed. Articles were selected and categorized by topic into incidence, aetiology, pathophysiology, and possible preventative measures.
Table
The case reports found on MEDLINE.
Author | Procedure | Tumour type, stage, and grade | Number of cases |
---|---|---|---|
Stolla et al., 1994 | Laparoscopic pelvic lymph node dissection | Bladder TCC pT3G2 | 1 |
Andersen et al.,1995 | Transperitoneal laparoscopic bladder biopsy | Bladder TCC T1G2 | 1 |
Bangma et al., 1995 | Laporoscopic pelvic lymph node dissection | PCa T3N1 | 1 |
Altieri et al., 1998 | Laporoscopic pelvic lymph node dissection | Bladder TCC T3G2 | 1 |
Ahmed et al., 1998 | Laparoscopic nephrectomy | Kidney TCC T3G3-G4 | 1 |
Otani et al., 1999 | Laparoscopic nephrectomy | Incidental finding of TCC, G3 within tuberculous atrophic kidney | 1 |
Fentie et al., 2000 | Laparoscopic nephrectomy | RCC T3N0G4 | 1 |
Landman and Clayman, 2001 | Laparoscopic nephrectomy | RCC T1N0G2 | 1 |
Castilho et al., 2001 | Laparoscopic nephrectomy | RCC T1N0G2 | 1 |
Wang et al., 2002 | Laparoscopic cystectomy | Incidental finding of SCC in ovarian dermoid cyst | 1 |
Chen et al., 2003 | Laparoscopic nephrectomy (hand assisted) | RCC T2N0M0 | 1 |
Rassweiler et al., 2003 | Laparoscopic adrenalectomy | Small-cell lung carcinoma adrenal metastasis | 1 |
Laparoscopic retroperitoneal lymph node dissection | NA | 1 | |
Saraiva P et al., 2003 | Laparoscopic adrenalectomy | Metastatic melanoma of adrenal gland. Grade unavailable | 1 |
Matsui et al., 2004 | Laparoscopic retroperitoneal nephroureterectomy | SCC pT3N0M0 | 1 |
Iwamura et al., 2004 | Laparoscopic retroperitoneal nephrectomy | RCC T1bN0M0 | 1 |
Micali et al., 2004 | Laparoscopic Adrenalectomy | Lung metastases pT4/G3 (3); Adrenocortical Ca-grade and stage NA (1) | 4 |
Laporoscopic pelvic lymph node dissection | Squamous penile Ca | 1 | |
Laparoscopic retroperitoneal lymph node dissection | Nonseminomatous Germ Cell Tumor | 1 | |
Laparoscopic simple nephrectomy | Incidental TCC in each instance—pT1/G2; pT1/G3; pT2/G3; NA | 4 | |
Laparoscopic nephroureterectomy | pT3/G3 | 3 | |
Naderi et al., 2004 | Laporoscopic nephroureterectomy | Kidney TCC cT1N0M0 | 1 |
Chueh et al., 2004 | Laporoscopic bilateral nephroureterectomy | Grade 2 renal TCC with pelvic muscular invasion and bladder metastasis | 1 |
Porpiglea et al., 2004 | Laparoscopic adrenalectomy | Adrenal metastasis from nonsmall cell lung carcinoma | 1 |
El-Tabey and Shoma, 2005 | Laparoscopic cystectomy (robot-assisted) | Bladder TCC T3bN0M0G3 | 1 |
Kobori et al., 2005 | Laparoscopic nephrectomy | Papillary adenocarcinoma of pelvis. Stage and grade unavailable | 1 |
Dhobada et al., 2006 | Laparoscopic nephrectomy | RCC T2N0M0G3 | 1 |
Manabe et al., 2007 | Laparoscopic nephroureterectomy | Upper tract transitional cell carcinoma without distant metastases | 1 |
Muntener et al., 2007 | Laparoscopic radical nephroureterectomy | Upper tract TCC. Stage T1, high grade | 1 |
Castillo and Vitagliano 2008 | Laparoscopic partial nephrectomy | RCC T1N0M0G3 | 1 |
Laparoscopic retroperitoneal lymph node dissection | Mixed germ cell tumor T3N0M0 | 1 | |
Cresswell et al., 2008 | Laporoscopic retroperitoneal lymph node dissection | Stage 1 nonseminomatous germ cell tumour. Grade NA | 1 |
Segawa et al., 2008 | Laparoscopic nephroureterectomy and cystectomy | Invasive bladder cancer with bone metastasis. Grade NA | 1 |
Spermon and Witjes 2008 | Laparoscopic retroperitoneal lymph node dissection | Stage IIb non seminomatous germ cell tumour (Histology-yolk sac and teratoma elements) | 1 |
Greco et al., 2009 | Laparoscopic partial nephrectomy | Renal clear cell papillary carcinoma pT1a, high grade | 1 |
Yasuda et al., 2009 | laparoscopic nephroureterectomy | Upper urinary tract carcinoma. T2N0M0 Grade 2 > 3 | 1 |
Huang et al., 2010 | Laparoscopic radical cystectomy and pelvic lymph node dissection | NA | 1 |
Pca = prostate cancer, RCC = Renal cell carcinoma, SCC cell carcinoma, NA = not available.
Etiological factor has been categorised in three main categories: tumour related, wound related, and surgical technique related. Surgical technique related factors have been categorised in two main categories: manipulation is the principal factor acting in tumour dissemination. Extraction of the surgical specimen is determined by the surgeon. The possible preventive measure has been categorised in two main categories: active measures and measures for reducing the risk of laparoscopic port-site metastasis in urological surgery.
Laparoscopic surgery is rapidly gaining widespread acceptance among urologists, including extensive application in malignant conditions [
Various theories tried to explain metastasis development at laparoscopic port site [
Tumor-related factors [
Wound-related factors [
Surgical technique-related factors [
However, it is logical to assume that morcellation of the specimen increases tumor seeding [
The problem is influenced to some extent by surgeon and operating team experience [
Port-site recurrence of tumour is a particular, and increasingly recognized [
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.