Axillary metastases after port site recurrences of gallbladder carcinoma: a case report.

BACKGROUND

Incidental gallbladder carcinoma is often discovered after elective laparoscopic cholecystectomy for cholecystitis or cholecystolithiasis. Port site recurrences may occur. Patients with port site metastases of gallbladder carcinoma have a poor prognosis.

CASE PRESENTATION

A 61-year-old man underwent an elective laparoscopic cholecystectomy because of cholecystitis and gallstones. Pathology revealed a gallbladder carcinoma. After referral to a tertiary center, radical re-resection followed. Three years later, an epigastric port site recurrence emerged, partially fixed to the xiphoid process. A wide abdominal wall resection was performed, including part of the xiphoid process. Follow-up was continued with periodical imaging and standard blood work. Three years after resection of this port site metastasis, the patient presented with an occasionally painful mass in the left axilla. Pathology revealed the presence of an adenocarcinoma, most likely arising from the prior gallbladder carcinoma. Given the extensive dissemination and limited symptoms in the axillary node, we decided against a surgical intervention, instead of adopting a wait-and-see policy. Disease progression occurred within 1 year, and the patient was treated with palliative radiotherapy, followed by palliative chemotherapy. The patient died of metastatic disease approximately 6.5 years after the initial cholecystectomy.

CONCLUSIONS

Port site recurrences of (incidental) gallbladder carcinoma occur after laparoscopic cholecystectomy, despite preventive perioperative measures. Patients with port site recurrences can develop axillary lymph node metastases, similar to other truncal malignancies. Surgical interventions should be limited.