Cancer of all stages can recur at port sites: gynecologic cancer.(Gynecology)

LAS VEGAS -- Gynecologic cancer of any stage may recur at laparoscopic port sites, Dr. Pedro T. Ramirez said at an international congress of the Society of Laparoendoscopic Surgeons.

Though the risk is small, it is not limited to patients diagnosed with advanced-stage cancer, according to a literature review conducted by Dr. Ramirez, a gynecologic oncologist at the University of Texas M.D. Anderson Cancer Center, Houston. In 58 patients with laparoscopic port-site metastases reported in 31 articles, metastases occurred after ovarian cancer (40 women), cervical cancer (12), uterine cancer (4), fallopian tube cancer (1), and vaginal cancer (1).

With so few cases, it's difficult to assess the effect of port-site metastases on prognosis, especially since the port site often was not the only site of recurrence. Nevertheless, surgeons should try to limit gynecologic laparoscopy to patients who clearly would benefit from the procedure.

Intraperitoneal and port-site lavage, particularly with povidone-iodine solution, may decrease the risk of port-site recurrence. Surgical technique modifications also may help reduce the risk. These modifications include trocar fixation, minimization of tissue trauma when dissecting a tumor, and deflation of the abdomen with the trocar in place to prevent the "chimney effect"--a rapid efflux of the gas used for pneumoperitoneum through the port site.

* Ovarian cancer. Forty ovarian cancer patients had port-site metastases. Thirty-three of these women initially had invasive disease, and seven had ovarian cancer of low malignant potential. Port-site recurrences were marked by early-stage disease in 20% and 60% of these women, respectively, Dr. Ramirez said. Port-site metastases appeared a median of 17 days after surgery. Factors that appeared to be associated with increased risk for port-site recurrence included carcinomatosis in 39 cases, ...