Schaeff B, Paolucci V, Thomopoulos J
Klinik für Allgemeinchirugie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main, Deutschland.
Dig Surg. 1998;15(2):124-34. doi: 10.1159/000018605.
Port site metastasis has been a surprising event after laparoscopic procedures in cancer patients. No clear data exist about this phenomenon. The aim of this study is to summarize current epidemiologic knowledge about the risk of this complication. A review of all case reports about port site recurrences was undertaken. To date, 164 cases of port site metastases after videoscopic procedures have been reported in 90 papers. We found 108 cases of implantation after laparoscopy for digestive tumors, 23 after thoracoscopy, 29 after gynecological and 4 after urological laparoscopy. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization to the trocars and instruments. Also low-staged and highly differentiated tumors have been reported to cause post-laparoscopy tumor seeding. The temporary data of the CAE registry 'port site metastases' (Workgroup for Surgical Endoscopy of the German Society of Surgery) are also reported. The analysis of 80 histologically confirmed cases of port site recurrence shows a particular frequency after laparoscopic cholecystectomy for unsuspected gallbladder cancer (n = 59). Postoperative specimen examination revealed a T1 carcinoma in 9 cases (15%), T2 carcinoma in 33 (21%), T3 in 3 (5%) and T4 in 1 case (1.7%). The mean time to clinical tumor relapse was 6 months. Similar patterns were found in a lower number of port site metastases after laparoscopy for colon cancer (n = 2) and for other cancers (n = 9). Clinical evidence that laparoscopy with CO2 pneumoperitoneum can enhance tumor dissemination is given. Port site metastases seem to be secondary to multiple factors including the gas used, local trauma, tumor manipulation, biologic properties of the tumor, and individual surgical skills.
端口部位转移一直是癌症患者腹腔镜手术后令人惊讶的事件。关于这一现象尚无明确数据。本研究的目的是总结当前关于这种并发症风险的流行病学知识。我们对所有关于端口部位复发的病例报告进行了综述。迄今为止，90篇论文中报道了164例视频手术术后端口部位转移病例。我们发现，腹腔镜下消化道肿瘤手术后有108例种植转移，胸腔镜手术后23例，妇科腹腔镜手术后29例，泌尿外科腹腔镜手术后4例。对当前文献的分析证实，腹腔镜手术会导致腹腔内细胞向套管针和器械移动。此外，低分期和高分化肿瘤也被报道会导致腹腔镜手术后肿瘤种植。我们还报告了德国外科学会外科内镜工作组CAE登记处“端口部位转移”的临时数据。对80例经组织学证实的端口部位复发病例的分析显示，在腹腔镜胆囊切除术中发现意外胆囊癌后出现端口部位转移的频率特别高（n = 59）。术后标本检查显示，9例（15%）为T1期癌，33例（21%）为T2期癌，3例（5%）为T3期癌，1例（1.7%）为T4期癌。临床肿瘤复发的平均时间为6个月。在腹腔镜结肠癌手术（n = 2）和其他癌症手术（n = 9）后出现的较少数量的端口部位转移中也发现了类似模式。有临床证据表明，使用二氧化碳气腹的腹腔镜手术会促进肿瘤播散。端口部位转移似乎是多种因素导致的，包括所用气体、局部创伤、肿瘤操作、肿瘤的生物学特性以及个体手术技巧。
