Port site metastases after minimally invasive resection for colorectal cancer: A retrospective study of 13 patients

Laparoscopic surgery is associated with increased risk of postoperative peritoneal metastases in T4 colon cancer: a propensity score analysis

BACKGROUND

This study aims to evaluate the postoperative safety, long-term survival, and postoperative peritoneal metastases (PPM) rate associated with laparoscopic surgery (LS) for T4 colon cancer.

MATERIALS AND METHODS

After propensity score matching, there were 68 patients in each of the LS and Open surgery groups. The primary outcomes were the 3-year OS, DFS, and PPM rates.

RESULTS

After matching, 68 patients in each of the groups. The LS group had a higher cumulative 3-year peritoneal metastasis rate (19.8% vs. 6.7%, P = .036), while the 3-year OS (82.3% vs. 83.8%, P = .750) and 2-year DFS (69.0% vs. 75.7%, P = .310) showed no significant difference, compared to the open surgery group. The LS group had a significantly longer operation time (201 ± 85.7 min vs. 164 ± 65.9 min, P = .008) but less postoperative complications (P = .036). Additionally, patients in the LS group removed gastric tube more quickly (1.91 ± 1.18 days vs. 2.69 ± 2.41 days, P = .048). The multivariate analysis revealed that LS (HR = 3.496, 95% CI = 1.108-11.030, P = .033), underweight (HR = 11.650, 95% CI = 2.155-62.990, P = .004), and lymphovascular invasion (HR = 3.123, 95% CI = 1.010-9.664, P = .048) were all predictive factors of PPM. For the pN + subgroup, the 3-year cumulative PPM rate was 29.6% in the LS group, significantly higher than 15.3% in the open group (P = .029), but there was no significant difference after PSM (P = .100).

CONCLUSION

LS offers faster postoperative recovery and comparable long-term survival outcomes. Therefore, it should remain a viable option for locally advanced T4 colon cancer. However, it is crucial to fully recognize the potential risk of increased PPM associated with LS, especially in patients with preoperative suspicion of positive lymph nodes. Further multicenter prospective studies are necessary to validate the potential risks of LS and gain insight into treatment efficacy in different patient populations. In addition, future studies should assess prognosis based on the grade and extent of peritoneal dissemination to provide a more nuanced understanding.

Iodine-125 Brachytherapy for Palliative Treatment of Painful Colorectal Cancer Port-Site Metastases

OBJECTIVE

To summarize the treatment process of a case of Iodine-125 Brachytherapy for Palliative Treatment of Painful Colorectal Cancer Port-Site Metastases.

METHODS

We present a case report of multifocal port-site metastases ( PSMs ) that developed in a patient with stage IV ascending colonic adenocarcinoma and mucinous cancer following laparoscopic surgery. After multiline therapy failed, painful PSMs treated with repeated iodine-125 seed implantation.

RESULTS

Severe abdominal discomfort were eventually successfully managed after receiving iodine-125 brachytherapy.

CONCLUSION

For painful PSMs, iodine-125 brachytherapy can be a safe and effective treatment option.

Prophylactic hyperthermic intraperitoneal chemotherapy in T4 colorectal cancer: Can it improve the oncologic prognosis? - A propensity score matching study

BACKGROUND

Some studies show that cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) may improve overall survival and is a possible curative treatment for selected colorectal cancer (CRC) patients with restricted peritoneal metastasis (PM). The value of HIPEC in preventing PM of CRC is still controversial.

MATERIALS AND METHODS

In this retrospective propensity score matching (PSM) cohort study, all patients with cT4N0-2M0 undergoing treatment at a single institution in China (2014-2018) were reviewed. The 3-year disease-free survival (DFS) was set as the primary outcome, and the 3-year PM rate was also analyzed.

RESULTS

220 patients were included in this study for analysis. After 1:3 PSM: HIPEC (n = 45) and No HIPEC (n = 135). Through analysis, it was found that prophylactic HIPEC correlated to better DFS [hazard ratio (HR) 0.43, 95 % confidence interval (CI) 0.19-0.95; p = 0.037], and N2 stage correlated to worse DFS [HR 1.97, 95 % CI 1.09-3.56; p = 0.025]. For laparoscopic surgery subgroup analyses, 3-year PM rate of patients with laparoscopic surgery was 13.8 % in No HIPEC group, and 2.6 % in HIPEC group (p = 0.070). Besides, no post-operative death occurred, the anastomotic leakage rate was 2.2 % in HIPEC group and 0.7 % in the control group (p = 0.439).

CONCLUSIONS

Prophylactic HIPEC may improve the prognosis in patients with cT4N0-1M0 CRC, but not in cT4N2M0 CRC, and it does not significantly increase surgery-related complications. Laparoscopic surgery followed by HIPEC for T4 stage CRC may not increase risk of PM.

Successful resection of port site recurrence of pancreatic ductal adenocarcinoma after laparoscopic distal pancreatectomy

BACKGROUND

There are many reports of port site recurrence after laparoscopic surgery for various types of cancer. However, only two cases of port site recurrence after laparoscopic pancreatectomy have been reported to date. We herein report a case of port site recurrence after laparoscopic distal pancreatectomy.

CASE PRESENTATION

A 73-year-old woman was diagnosed with pancreatic tail cancer and underwent laparoscopic distal pancreatectomy with splenectomy. Histopathological examination revealed pancreatic ductal carcinoma (pT1N0M0 pStage I). The patient was discharged on postoperative day 14 with no complications. However, 5 months after surgery, computed tomography showed a small tumor at the right abdominal wall. No distant metastasis had appeared after 7 months of follow-up. Under the diagnosis of port site recurrence without any other metastases, we resected this abdominal tumor. Histopathological examination showed port site recurrence of pancreatic ductal carcinoma. No recurrence was observed 15 months postoperatively.

CONCLUSIONS

This is the report of successful resection of port site recurrence of pancreatic cancer.

Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies

Background

To evaluate short- and long-term outcomes of laparoscopic colectomy (LC) vs. open colectomy (OC) in patients with T4 colon cancer.

Methods

Three authors independently searched PubMed, Web of Science, Embase, Cochrane Library, and Clinicaltrials.gov for articles before June 3, 2022 to compare the clinical outcomes of T4 colon cancer patients undergoing LC or OC.

Results

This meta-analysis included 7 articles with 1,635 cases. Compared with OC, LC had lesser blood loss, lesser perioperative transfusion, lesser complications, lesser wound infection, and shorter length of hospital stay. Moreover, there was no significant difference between the two groups in terms of 5-year overall survival (5y OS), and 5-year disease-free survival (5y DFS), R0 resection rate, positive resection margin, lymph nodes harvested ≥12, and recurrence. Trial Sequential Analysis (TSA) results suggested that the potential advantages of LC on perioperative transfusion and the comparable oncological outcomes in terms of 5y OS, 5y DFS, lymph nodes harvested ≥12, and R0 resection rate was reliable and no need of further study.

Conclusions

Laparoscopic surgery is safe and feasible in T4 colon cancer in terms of short- and long-term outcomes. TSA results suggested that future studies were not required to evaluate the 5y OS, 5y DFS, R0 resection rate, positive resection margin status, lymph nodes harvested ≥12 and perioperative transfusion differences between LC and OC.

Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297792.

Robot-Assisted Partial Cystectomy versus Open Partial Cystectomy for Patients with Urachal Cancer

INTRODUCTION

Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial cystectomy (RAPC) is an alternative approach, of which its safety and efficacy for UrC remains to be determined. In the present study, we analyze these outcomes after RAPC, compared with OPC.

METHODS

We retrospectively evaluated 55 cN0M0 UrC patients who underwent RAPC (n = 8) or OPC (n = 47) between 1994 and 2020. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods. Positive surgical margins (PSM), port-site recurrences (PSR) versus wound recurrences were compared. Complications were recorded using the Clavien-Dindo classification.

RESULTS

Median follow-up was 40 months (IQR 21-95). Two-year OS and RFS for RAPC were 73% (95% confidence intervals (CI); 56-89 months) and 60% (95% CI; 42-78 months), respectively, versus 90% (95% CI; 85-95 months) and 66% (95% CI; 59-73 months) for OPC. PSM rate was 13% in both groups. PSR occurred in 2/8 (25%) patients after RAPC. No wound recurrences occurred after OPC. Postoperative complications occurred in 2/8 (25%) patients after RAPC, versus 5/47 (11%) after OPC (p = 0.27).

CONCLUSION

Both RAPC and OPC seem feasible surgical modalities to treat localized UrC with comparable survival. The PSR rate of 25% after RAPC should prompt us to be cautious to recommend RAPC as no such recurrences were seen using OPC.

Solitary port-site metastasis 42 months after laparoscopic distal gastrectomy for gastric cancer

We report a case of solitary port-site recurrence after laparoscopy-assisted distal gastrectomy for advanced gastric cancer. A 66-year-old man had previously undergone laparoscopy-assisted gastrectomy with regional lymph-node dissection for advanced gastric cancer, which was a poorly differentiated adenocarcinoma invading the subserosal layer with lymphatic infiltration and no lymph-node metastases. He experienced dull pain in the left upper quadrant of the abdomen 42 months after the surgery. On physical examination, erythematous induration of the skin around the scar of the port insertion was observed in the left upper quadrant of the abdomen. Abdominal ultrasonography and contrast-enhanced computed tomography revealed a subcutaneous lesion with a well-defined mass measuring 3.0 cm in diameter located in the left upper quadrant of the abdomen. A skin biopsy revealed a metastatic adenocarcinoma from gastric cancer. Since there was no evidence of further metastatic lesions in other organs, the patient underwent surgical resection of the metastatic tumor arising at the port site. The abdominal wall tumor was resected with a leaf-skin incision and an adequate safety margin, and the inferior border of the tumor reached the muscular layer, which was resected with the tumor. Pathological examination confirmed the diagnosis of a poorly differentiated adenocarcinoma in the subcutaneous tissue with invasion of the muscle layer at the port site. The postoperative course was uneventful; chemotherapy using oxaliplatin plus S-1 was administered, and the patient was in good health with no evidence of the disease for 3 months postoperatively. Although port-site metastasis after laparoscopic gastrectomy for gastric cancer is a rare recurrence form, we should be aware of this issue, and further studies and assessments of additional cases are needed to establish a treatment strategy.

Atypical Metastases in the Abdomen and Pelvis From Biochemically Recurrent Prostate Cancer: 11C-Choline PET/CT Imaging With Multimodality Correlation

PET imaging with targeted radiotracers has become integral for mapping the location and burden of recurrent disease in patients with biochemical recurrence (BCR) of prostate cancer (PCa). PET with 11C-choline is part of the National Comprehensive Cancer Network and European Association of Urology guidelines for evaluation of BCR. With advances in PET technology, increasing use of targeted radiotracers, and improved survival of patients with BCR due to novel therapeutics, atypical sites of metastases are being increasingly encountered, challenging the conventional view that PCa rarely metastasizes beyond bones or lymph nodes. We describe such atypical metastases in the abdomen and pelvis on 11C-choline PET (including in the liver, pancreas, genital tract, urinary tract, peritoneum, and abdominal wall, as well as perineural spread), presenting multimodality imaging features and relevant imaging pitfalls. Given atypical metastases' inconsistent relationship with serum PSA and non-specific presenting symptoms, they are often first detected on imaging. Awareness of their imaging features is important as their detection impacts clinical management, patient counseling, prognosis, and clinical trial eligibility. Such awareness is particularly critical as the role of radiologists in the imaging and management of BCR will continue to increase given the expanding regulatory approvals of other targeted and theranostic radiotracers.

Laparoscopy technique in the setting of peritoneal metastases to avoid port site relapse

BACKGROUND

Laparoscopy is indicated in many patients with abdominal and pelvic malignancy. If cancer cells are present within the peritoneal space, there is a possibility for port site metastases to develop.

METHODS

The pathophysiology for occurrence of port site metastases was reviewed. Technical modifications to reduce the incidence of these abdominal wall sites for disease progression were suggested.

RESULTS

Evacuation of all gases and all fluid from the peritoneal space through the trocars prior to their removal will reduce the contamination of the tissue surrounding the port site by intraperitoneal cancer cells. If port sites are confined to the midline, they can be removed as part of a midline abdominal incision if metastases occur. If port site metastases occur through lateral port sites, the rectus abdominus muscle may need to be widely excised to achieve negative margins.

CONCLUSION

Technical modifications of laparoscopy in patients with peritoneal metastases may reduce incidence of this iatrogenic dissemination of cancer.

Surgical complications in colorectal cancer patients

BACKGROUND

Advancements in diagnostic and therapeutic sciences have allowed early diagnosis and treatment of cancer. Colorectal cancer is one of the most commonly reported cancers, particularly in elderly patients.

METHODS

Open and laparoscopic surgeries are used for the removal of the tumor, along with chemotherapy, depending on the stage of cancer. However, colorectal cancer surgery is associated with a great number of complications, that affect the efficacy of the surgery and overall health and survival of the patient.

RESULTS

Prevalence of these complications have shown discrepancies depending on the condition of the patient and disease and surgical skills of the surgeon. Preoperative evaluation, intraoperative care and postoperative measures can reduce the incidence of these complications.

CONCLUSION

This review highlights some frequently reported complications associated with colorectal cancer surgery, their risk factors and subsequent therapeutic measures to treat them.

Rectus abdominis muscle transplant for repair of abdominal wall defects required for cancer resections: Case report

BACKGROUND

Cancer cells from peritoneal metastases may gain access to tissues of the abdominal wall. If laparotomy or laparoscopy is performed in a patient with peritoneal metastases, the abdominal incision or trochar sites may become seeded by cancer cells. Progression of disease may require resection if cancer at other sites can be controlled.

METHODS

Metastases in an appendectomy incision occurred from peritoneal metastases of an appendiceal mucinous adenocarcinoma. The clinical features and treatment strategy of this condition in a single patient was studied.

RESULTS

In this patient, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was used to eradicate the peritoneal metastases. The cancer isolated within the appendectomy site was resected leaving a large abdominal wall defect. The defect was closed by a rectus abdominis muscle flap dissected from the contralateral side of the abdominal wall. No mesh was required.

CONCLUSIONS

Abdominal wall defects from resection of cancerous masses of the abdominal wall can be closed with a contralateral rectus abdominis muscle transplant in the absence of mesh.

Port site recurrence, an unintended consequence of laparoscopic resection of ovarian cancer. A case report

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The goal of cancer surgery is complete removal and absolute containment of the malignant process.

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Laparoscopy performed with cancer cells within the peritoneal space may cause cancer progression within trochar sites.

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This unintended adverse consequence of laparoscopy may be reduced by limiting trochar sites to the midline.

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Prospective data regarding the incidence of trochar site disease is not available but it does continue to occur.

Background

Cancer surgery has as its goal complete clearance and absolute containment of the malignant disease as it is being resected. Any aspect of the procedure which allows the escapes of malignant cells may result in disease recurrence.

Methods

The patient presented to an emergency room with left-sided abdominal pain. Pelvic sonogram suggested the diagnosis of a ruptured left ovarian cyst. A uterine biopsy showed high grade serous carcinoma. Definitive treatment of the primary ovarian cancer wasen bloc laparoscopic resection of her uterus, Fallopian tube and ovaries.

Results

CT showed port site recurrence in both right and left upper abdominal trochar sites. The right-sided port site recurrence was through the fascia just lateral to the right rectus muscle and was small. A much larger port site metastases was present at the right trochar site that was through the left rectus muscle.

Conclusion

The incidence of midline and lateral port site recurrence after laparoscopy for diagnosis or resection of ovarian cancer has not been determined. Limitation of trochar sites to the midline may reduce the extent of abdominal wall disease spread.