Port-Site Metastasis after Laparoscopic Surgery with Rapid Second Recurrence in Early Stage Endometrial Carcinoma: A Case Report and Review of the Literature

Abstract

Introduction: Port site metastases have been reported with laparoscopic surgery. The mechanism of action is unknown. Theories include tumor tracking, spillage, pneumoperitoneum, and immune factors. Methods: We report on a case of aggressive port site metastases and intra-abdominal recurrence after an uncomplicated laparoscopic hysterectomy for a grade 2, minimally invasive endometrioid adenocarcinoma of the uterus. The world literature on port site metastases in gynecological cancer is reviewed. Results: Port site metastases have two distinct presentations. In the first pattern, the metastases are isolated to the laparoscopic port sites. In the second pattern, port site metastases are associated with widespread intra-abdominal recurrence. Conclusion: Port site metastases are rare but occur with laparoscopic surgery. Meticulous attention to surgical technique including the use of specimen bags to isolate tissue and prevent spillage should be performed. Data registries should be instituted to track the incidence and outcomes of port site metastases.