Khetrapal Pramit, Tan Wei Shen, Lamb Benjamin, Nathan Senthil, Briggs Tim, Shankar Arjun, Ramachandran Navin, Freeman Alex, Mitra Anita, Kelly John D
Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
Clin Genitourin Cancer. 2017 Aug;15(4):440-444. doi: 10.1016/j.clgc.2016.06.012. Epub 2016 Jun 29.
Port-site metastases (PSMs) are a rare occurrence after robotic surgery. For robot-assisted radical cystectomy (RARC), isolated cases have been reported but management has not been previously described. We present a case of PSM that occurred after RARC and report the results of our systematic review of previously reported PSMs and describe the treatment options. Search Criteria and Methods: We describe a case of a PSM in a 55-year-old man who had undergone intracorporeal RARC. We performed a systematic review of MEDLINE and Embase databases for previously reported PSMs, detailing the stage and grade of the primary tumor, time to presentation of PSM, treatment offered, and outcomes for the identified cases.
We identified 4 cases of PSMs after RARC in published studies and also included our case for analysis. All 5 patients had muscle-invasive bladder cancer at cystectomy (stage ≥ T2) and 3 had local lymph node-positive disease. Our aggressive treatment of chemotherapy, wide surgical excision of PSM, and radiotherapy provided our patient with a 2-year disease-free status.
PSMs are a rare event in RARC, with only 4 other cases reported in published studies. The outcomes have not been well reported for these cases. We propose that multimodality treatment consisting of salvage chemotherapy, surgery, and radiotherapy should be considered, although concessions could be needed after consideration of patient factors.
机器人手术后发生切口转移（PSMs）较为罕见。对于机器人辅助根治性膀胱切除术（RARC），虽有个别病例报道，但此前尚未描述其处理方法。我们报告一例RARC术后发生的PSM病例，并汇报我们对既往报道的PSM病例进行系统评价的结果，同时描述治疗选择。检索标准和方法：我们描述一例55岁男性患者在接受体内RARC术后发生PSM的病例。我们对MEDLINE和Embase数据库进行了系统检索，以查找既往报道的PSM病例，详细记录原发肿瘤的分期和分级、PSM出现的时间、所提供的治疗以及确诊病例的结局。
我们在已发表的研究中确定了4例RARC术后发生PSM的病例，并将我们的病例纳入分析。所有5例患者在膀胱切除时均为肌层浸润性膀胱癌（分期≥T2），3例有局部淋巴结阳性疾病。我们积极采用化疗、广泛手术切除PSM以及放疗，使我们的患者获得了2年无病状态。
PSM在RARC中是罕见事件，已发表研究中仅报道了另外4例。这些病例的结局报道不佳。我们建议应考虑采用包括挽救性化疗、手术和放疗在内的多模式治疗，不过在考虑患者因素后可能需要做出让步。
