Port-Site Metastasis after Laparoscopic Surgery with Rapid Second Recurrence in Early Stage Endometrial Carcinoma: A Case Report and Review of the Literature


Introduction: Port site metastases have been reported with laparoscopic surgery. The mechanism of action is unknown. Theories include tumor tracking, spillage, pneumoperitoneum, and immune factors. Methods: We report on a case of aggressive port site metastases and intra-abdominal recurrence after an uncomplicated laparoscopic hysterectomy for a grade 2, minimally invasive endometrioid adenocarcinoma of the uterus. The world literature on port site metastases in gynecological cancer is reviewed. Results: Port site metastases have two distinct presentations. In the first pattern, the metastases are isolated to the laparoscopic port sites. In the second pattern, port site metastases are associated with widespread intra-abdominal recurrence. Conclusion: Port site metastases are rare but occur with laparoscopic surgery. Meticulous attention to surgical technique including the use of specimen bags to isolate tissue and prevent spillage should be performed. Data registries should be instituted to track the incidence and outcomes of port site metastases.

Share and Cite:

Outaggarts, Z. , Johnstone, S. and Goodman, A. (2015) Port-Site Metastasis after Laparoscopic Surgery with Rapid Second Recurrence in Early Stage Endometrial Carcinoma: A Case Report and Review of the Literature. Open Journal of Obstetrics and Gynecology, 5, 324-332. doi: 10.4236/ojog.2015.56047.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Tsuyoshi, O., Kuan-Gen, H., Renee, V., Ueng, S.H. and Lee, C.L. (2012) Unusual Trocar Site Metastasis in a Uterine Leiomyosarcoma after Laparoscopic Hysterectomy. Journal of Minimally Invasive Gynecology, 19, 252-254.
[2] Zivanovic, O., Sonoda, Y., Diaz, J.P., Levine, D.A., Brown, C.L., Chi, D.S., Barakat, R.R. and Abu-Rustum, N.R. (2008) The Rate of Port-Site Metastases after 2251 Laparoscopic Procedures in Women with Underlying Malignant Disease. Gynecologic Oncology, 111, 431-437.
[3] Martinez, A., Querleu, D., Leblanc, E., Narducci, F. and Ferron, G. (2010) Low Incidence of Port-Site Metastases after Laparoscopic Staging of Uterine Cancer. Gynecologic Oncology, 118, 145-150.
[4] Palomba, S., Falbo, A., Russo, T. and LaSala, G.B. (2012) Port-Site Metastasis after Laparoscopic Surgical Staging of Endometrial Cancer: A Systematic Review of the Published and Unpublished Data. Journal of Minimally Invasive Gynecology, 19, 531-537.
[5] Palomba, S., Falbo, A., Oppedisano, R., Russo, T. and Zullo, F. (2012) Isolated Port-Site Metastasis after Laparoscopic Surgery for Endometrial Cancer: A Case Report. Gynecologic Oncology Reports, 2, 16-17.
[6] Kadar, N. (1997) Port-Site Recurrences Following Laparoscopic Operations for Gynaecological Malignancies. Obstetrics & Gynecology, 104, 1308-1313.
[7] Muntz, H.G., Goff, B.A., Madsen, B.L. and Yon, J.L. (1999) Port-Site Recurrence after Laparoscopic Surgery for Endometrial Carcinoma. Obstetrics & Gynecology, 93, 807-809.
[8] Faught, W. and Fung Kee Fung, M. (1999) Port Site Recurrences Following Laparoscopically Managed Early Stage Endometrial Cancer. International Journal Gynecological Cancer, 9, 256-258.
[9] Sanjuán, A., Hernández, S., Pahisa, J., Ayuso, J.R., Torné, A., Martínez Román, S., Lejárcegui, J.A., Ordi, J. and Vanrell, J.A. (2005) Port-Site Metastasis after Laparoscopic Surgery for Endometrial Carcinoma: Two Case Reports. Gynecologic Oncology, 96, 539-542.
[10] Wang, P.H., Yen, M.S., Yuan, C.C., Chao, K.C., Ng, H.T., Lee, W.L. and Chao, H.T. (1997) Port Site Metastasis after Laparoscopic-Assisted Vaginal Hysterectomy for Endometrial Cancer: Possible Mechanisms and Prevention. Gynecologic Oncology, 66, 151-155.
[11] Maenpaa, J.U., Nyberg, R. and Parkkinen, J. (2009) Port-Site Metastasis Following Laparoscopic Hysterectomy and Bilateral Salpingo-Ophorectomy for Endometrial Carcinoma. European Journal of Obstetrics & Gynecology and Reproductive Biology, 143, 61-62.
[12] Falanga, A. and Zacharski, L. (2005) Deep Vein Thrombosis in Cancer: The Scale of the Problem and Approaches to Management. Annals of Oncology, 16, 696-701.
[13] Sorensen, H.T., Mellemkjaer, L., Olsen, J.H. and Baron, J.A. (2000) Prognosis of Cancers Associated with Venous Thromboembolism. The New England Journal of Medicine, 343, 1846-1850.
[14] Childers, J.M., Aqua, K.A., Surwit, E.A., Hallum, A.V. and Hatch, K.D. (1994) Abdominal-Wall Tumor Implantation after Laparoscopy for Malignant Conditions. Obstetrics & Gynecology, 84, 765-769.
[15] Kruttwagen, R.F.P.M., Swinkels, B.M., Keyser, K.G.G., Doesburg, W.H. and Schijf, C.P.T. (1996) Incidence and Effect on Survival of Abdominal Wall Metastases at Trocar or Puncture Sites Following Laparoscopy or Paracentesis in Women with Ovarian Cancer. Gynecologic Oncology, 60, 233-237.
[16] Chua, T.C., Yan, T.D., Morris, D.L. and Sugarbaker, P.H. (2011) Port-Site Metastasis Following Laparoscopic Surgery. In: Shamsa, A., Ed., Advanced Laparoscopy, Chap. 11, InTech.
[17] Spirtos, N.M., Schlaerth, J.B., Gross, G.M., Spirtos, T.W., Schlaerth, A.C. and Ballon, S.C. (1996) Cost and Quality-of-Life Analyses of Surgery for Early Endometrial Cancer: Laparotomy versus Laparoscopy. American Journal of Obstetrics & Gynecology, 174, 1795-1800.
[18] Macias, V., Baiotto, B., Pardo, J., Munoz, F. and Gabriele, P. (2003) Laparotomy Wound Recurrence of Endometrial Carcinoma. Gynecologic Oncology, 91, 429-434.
[19] Balbi, G.C., Cardone, A., Monteverde, A., Passaro, M., Montone, L., Rossiello, R., Visconti, S., Battista, M., Cassese, E. and Landino, I. (2006) Double Laparotomy Wound Recurrence of Endometrial Carcinoma. European Journal of Gynaecological Oncology, 27, 307-309.
[20] Tseng, L.N., Berends, F.J., Wittich, P.H., Bouvy, N.D., Marquet, R.L., Kazemier, G. and Bonjer, H.J. (1998) Port-Site Metastases: Impact of Local Tissue Trauma and Gas Leakage. Surgical Endoscopy, 12, 1377-1380.
[21] Menes, T. and Spivak, H. (2000) Laparoscopy: Searching for the Proper Insufflation Gas. Surgical Endoscopy, 14, 1050-1056.
[22] Moreira, H.J., Yamaguchi, T., Wexner, S., Singer, L., Zhao, R., Baig, M.K., Mack. J.A., Xiong, H. and Abramson, S. (2001) Effect of Pneumoperitoneal Pressure on Tumor Dissemination and Tumor Recurrence at Port-Site and Midline Incisions. American Surgeon, 67, 369-373.
[23] Hubens, G., Pauwels, M., Hubens, A., Vermeulen, P., Van Marck, P. and Eyskens, E. (1996) The Influence of a Pneumoperitoneum on the Peritoneal Implantation of Free Intraperitoneal Colon Cancer Cells. Surgical Endoscopy, 10, 809-812.
[24] Hirabayashi, Y., Yamaguchi, K., Shiraishi, N., Adachi, Y., Kitamura, H. and Kitano, S. (2002) Development of Port-Site Metastasis after Pneumoperitoneum. Surgical Endoscopy, 16, 864-868.
[25] Ost, M.C., Patel, K.P., Rastinehad, A.R., Chu, P.Y., Anderson, A.E., Smith, A.D. and Lee, B.R. (2008) Pneumoperitoneum with Carbon Dioxide Inhibits Macrophage Tumor Necrosis Factor-Alpha Secretion: Source of Transitional-Cell Carcinoma Port-Site Metastasis, with Prophylactic Irrigation Strategies to Decrease Laparoscopic Oncologic Risks. Journal Endourology, 22, 105-112.
[26] Evrard, S., Falkenrodt, A., Park, A., Tassetti, V., Mutter, D. and Marescaux, J. (1997) Influence of CO2 Pneumoperitoneum on Systemic and Peritoneal Cell-Mediated Immunity. World Journal Surgery, 21, 353-357.
[27] Ramirez, P.T., Wolf, J.K. and Levenback, C. (2003) Laparoscopic Port-Site Metastases: Etiology and Prevention. Gynecologic Oncology, 91, 179-189.
[28] Ndofor, B.T., Soliman, P.T., Schmeler. K.M., Nick, A.M., Frumovitz, M. and Ramirez, P.T. (2011) Rate of Port-Site Metastasis is Uncommon in Patients Undergoing Robotic Surgery for Gynecological Malignancies. International Journal of Gynecological Cancer, 21, 936-940.
[29] Thomas Jr., C.G. (1961) Tumor Cell Contamination of the Surgical Wound: Experimental and Clinical Observations. Annals Surgery, 153, 697-705.
[30] Wang, P.H., Yuan, C.C., Lin, G., Ng, H.T. and Chao, H.T. (1999) Risk Factors Contributing to Early Occurrence of Port Site Metastases of Laparoscopic Surgery for Malignancy. Gynecologic Oncologoy, 72, 38-44.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.