Department of General Surgery at MedStar Washington Hospital Center. Washington, DC, 20010, USA.
Colorectal Surgery Program at MedStar Washington Hospital Center. Washington, DC, 20010, USA.
Surg Oncol. 2019 Jun;29:20-24. doi: 10.1016/j.suronc.2019.02.008. Epub 2019 Feb 12.
Minimally invasive surgeries are increasingly being performed for primary colon cancer resections since laparoscopic and robotic surgeries have less post-operative pain, shorter length of hospitalization, less morbidity, improved patient satisfaction and equivalent R0 resection rates compared to laparotomy.
To analyze characteristics of patients who developed port site metastases after minimally invasive colectomy, a retrospective case series of a single institution from 2004 to 2017 was performed. The study included patients who had a minimally invasive resection of the primary colon cancer and subsequent cytoreduction and heated intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal metastases. Patient characteristics, histology, pathology, prior treatments, time between surgeries, carcinoembryonic antigen (CEA) levels and survival were reviewed.
There were 123 patients who had CRS/HIPEC and 13 of them had a history of laparoscopic or robotic colectomy followed by the development of port site disease. Four were females, nine were males. Median age was 48 years (range, 19-64). Eleven of 13 primary colon cancers were T3 or T4. Ten of 13 patients had no clinical evidence of peritoneal metastases at the time of initial resection. All 13 patients had metastatic deposits at port sites that were confirmed histopathologically at the time of CRS/HIPEC.
Port site metastases were present concomitantly with peritoneal metastases in 13 patients. An advanced T-stage of disease occurred in 85% of patients. Port site metastases do occur after minimally invasive colon resection.
由于腹腔镜和机器人手术与剖腹手术相比，术后疼痛较轻、住院时间较短、发病率较低、患者满意度提高且 R0 切除率相当，因此越来越多地对原发性结肠癌切除术进行微创。
为分析微创结肠切除术后发生切口转移的患者的特征，对 2004 年至 2017 年单机构的回顾性病例系列进行了研究。本研究包括接受微创原发性结肠癌切除术和随后进行腹膜转移细胞减灭术和腹腔内热化疗（CRS/HIPEC）的患者。回顾了患者特征、组织学、病理学、既往治疗、手术间隔时间、癌胚抗原（CEA）水平和生存情况。
有 123 例患者接受了 CRS/HIPEC，其中 13 例有腹腔镜或机器人结肠切除术病史，随后出现切口部位疾病。其中 4 例为女性，9 例为男性。中位年龄为 48 岁（范围，19-64）。13 例原发性结肠癌中有 11 例为 T3 或 T4。13 例患者中有 10 例在初始切除时无腹膜转移的临床证据。所有 13 例患者均在 CRS/HIPEC 时经组织病理学证实存在切口部位的转移性沉积物。
13 例患者同时存在切口部位转移和腹膜转移。85%的患者疾病处于晚期 T 期。微创结肠切除术后确实会发生切口转移。
