Trocar-site metastasis after laparoscopic gynecologic oncologic surgery

Chung, Min Ji; Lee, Jeong Mi; Kim, Yoon Jeong; Park, Il Soo; Cho, Young Lae; Lee, Yoon Soon

Abstract

OBJECTIVE
The purpose of this study was to evaluate the incidence of abdominal-wall tumor implantation after laparoscopic procedure in patients with gynecologic malignancies.
METHODS
The records of 184 patients who had a laparoscopic operations or laparotomy after laparoscopic diagnostic procedures from Aug. 1994 to Aug. 2003 in our hospital were reviewed. The presence of metastasis at trocar site of laparoscopic surgery and incision site of laparotomy was examined.
RESULTS
Abdominal-wall tumor implantations were developed at two port site in one patient. This result showed an incidence of 0.24% (2/819), as 2 ones in 819 abdominal trocar sites and 0.5% (1/184), as 1 in 184 procedures. This patient had a FIGO stage III a, grade2 adenocarcinoma of endometrium and underwent laparoscopic modified radical hysterectomy with both pelvic lymphadenectomy. In addition, tumor implantation was occurred at laparotomy skin incision site in one patient, a incidence of 2.2% (1/45), as 1 in 45 laparotomy procedures. This patient had a stage II, squamous cell carcinoma of the vagina, who had received second courses of Ifosfamide-Cisplantin neoadjuvant chemotherapy and open laparotomy with radical hysterectomy with upper vaginectomy was followed by laparoscopic pelvic lymphadenectomy due to fixed grossly metastatic nodes.
CONCLUSION
Recently, the use of laparoscopic procedure in oncology was increased, the new complication such as abdominal-wall implantation at trocar site was introduced. The abdominal-wall implantation at trocar site could be prevented by patients selection, intraperitoneal and port-site lavage, surgical modification. And all patients should have careful follow up with special attention to the trocar sites. Port site implantation was rare, but could be occurred in the incidence of 0.5% per procedure.