Page 23 - WJOLS - Journal of Laparoscopic Surgery

MSR Pradeep, V Sandeep Kumar
(Cont’d…)
Number
Author Procedure Tumor type, stage, and grade of cases
Landman and Laparoscopic nephrectomy RCC T1N0G2 1
Clayman 56
Fentie et al 57 Laparoscopic nephrectomy RCC T3N0G4 1
Otani et al 58 Laparoscopic nephrectomy Incidental finding of TCC, G3 within 1
tuberculous atrophic kidney
Ahmed et al 59 Laparoscopic nephrectomy Kidney TCC T3G3-G4 1
Altieri et al 60 Laparoscopic pelvic lymph node dissection Bladder TCC T3G2 1
Bangma et al 61 Laparoscopic pelvic lymph node dissection PCa T3N1 1
Andersen et al 62 Transperitoneal laparoscopic bladder biopsy Bladder TCC T1G2 1
Stolla et al 17 Laparoscopic pelvic lymph node dissection Bladder TCC pT3G2 1

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the published literature up to 2017 recovered 40 articles Tsivian and Sidi alone reported nine cases of PSMs
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comprising almost 60 cases for the words “port-site after urologic laparoscopy, and Rassweiler et al pub-
metastasis” and “urology.” lished eight local recurrences observed in 1,098 laparo-
Etiological factors have been categorized into three scopic procedures for urologic malignancies. Single case
main categories: Tumor-related, wound-related, and of PSM after prostatic adenocarcinoma has been reported
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surgical technique-related factors. Surgical technique- by De Bruyne et al and usually associated with poor
related factors have been categorized into two main prognosis.
categories: Manipulation is the principal factor acting in For port-site tumor recurrence to occur, several con-
tumor dissemination. Extraction of the surgical specimen ditions must be present. There must be release of viable
is determined by the surgeon. The possible preventive cancer cells from the tumor. There must be a mechanism
measure has been categorized into two main categories: by which these tumor cells are transported to the port site.
Active measures and measures for reducing the risk of Lastly, implantation of the tumor cells at the port site and
laparoscopic PSM in urological surgery. subsequent growth must occur. It has been hypothesized
that several factors may aid in this process, namely (1)
DISCUSSION the biologic aggressiveness of the tumor, (2) local wound
In urothelial cancers, port-site recurrence has been factors, (3) host immune responses, and (4) laparoscopic
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reported in a total of 13 cases, as reviewed by Micali et al surgical techniques. 13
in an international survey of 19 urologic laparoscopic Biological aggressiveness of the tumor, represented
centers performing a total of 18,750 laparoscopic proce- by grade and stage, plays a decisive role in possible
dures for urologic malignancies. The incidence was 0.12% tumor seeding determination, explaining why grades II
(13 of 10,912). Majority of port-site recurrences reported in and III TCCs represent the majority of PSMs in urological
this survey represented TCC. Of these 13 cases, there were procedures. 13

4 metastatic adrenal carcinomas, 4 urothelial carcinomas, Local wound factors help in the implantation and
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3 nephroureterectomy cases of upper urothelial carcinoma, proliferation of tumor cells at the port site. Cancer cells
1 case of retroperitoneal lymph node resection for testicu- have high proliferation potential within healing skin
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lar cancer, and 1 case of lymph node resection for penile incisions or intestinal anastomosis. Tumor cells implant
cancer. Port-site metastasis after laparoscopic extirpative more easily and successfully during early wound healing,
surgery for renal-cell carcinoma (RCC) is extremely rare. adhering to fibrin deposited at the site of surgical wound
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Micali et al identified no instances of port-site recurrence as a part of normal healing. The presence of growth
in 2,604 cases of laparoscopic radical nephrectomy for RCC. factors at the wound site promotes the survival and
Port-site metastasis is a rare complication of laparo- propagation of these cancer cells. As suggested by few
scopic intervention in urologic malignancies. Of the more animal studies, the port-site incision is more conducive
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than 50 reported cases of PSM in the urologic oncology than the laparotomy incision for tumor seeding. Aoki
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literature, only 10 have occurred after surgery for RCC. et al suggest that repair of the peritoneum at the trocar
First case of camera PSM after robot-assisted partial entry site may reduce the risk of tumor implantation and
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nephrectomy was reported by Song et al. The estimated subsequent recurrence.
incidence of PSM for robotic cystectomy is <0.5%. This Immune depression of the peritoneum occurs during
is higher than the overall PSM rate for urologic cancers laparoscopic insufflation as demonstrated by macrophage
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(0.09%). The incidence of tumor seeding in general lapa- function alteration, resulting in tumor recurrence and
roscopic surgery ranges from 0.8 to 21%. 8,9 metastasis. 21-25 Overall, immune function is diminished
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