Port-site metastases following laparoscopic surgery

Susan Neuhaus, Michael Texler, Peter Hewett, David Watson

Research output: Contribution to journalArticlepeer-review

146 Citations (Scopus)

Abstract

Background

Application of laparoscopy to the resection of malignancy has been followed by a literature describing cases of metastatic involvement at laparoscopic port sites. These include patients who underwent surgery for early stage carcinoma and instances following laparoscopic procedures during which tumours were not dissected.
Methods

Recently published clinical and experimental studies, and case reports related to this problem are reviewed; their relevance is discussed.
Results

Experimental studies incorporating bench top and large animal models have confirmed that tumour cells may be redistributed to port sites during laparoscopic surgery either directly from contaminated instruments or indirectly via the insufflation gas. Small animal models suggest that the incidence of wound metastasis is increased following conventional laparoscopic surgery, and that it may be decreased by gasless laparoscopy or helium insufflation. This evidence suggests that the development of port‐site metastases depends not only on the physical redistribution of tumour cells but also on the specific insufflation gas used, possibly because of influences on local metabolic or immune factors acting at the wound site.
Conclusion

Further research in this area is urgent. Until the issue is better understood, patients undergoing laparoscopic surgery for malignancy should be entered into clinical trials.
Original languageEnglish
Pages (from-to)735-741
Number of pages7
JournalBritish Journal of Surgery
Volume85
Issue number6
DOIs
Publication statusPublished - Jun 1998
Externally publishedYes

Keywords

  • laparoscopy
  • port sites
  • metastasis
  • insufflation

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