Management of port-site metastasis after laparoscopic surgery for ovarian cancer

OBJECTIVE: The purpose of this study was to define the clinical features and long-term prognosis of port-site metastasis after primary laparoscopic surgery for ovarian cancer. STUDY DESIGN: All the patients with epithelial ovarian cancer or borderline malignancy who had undergone primary laparoscopic surgery at our institution were reviewed. The clinicopathologic parameters, flow cytometric parameters, p53, p27, bax, HER-2/neu, and bcl-2 by immunostaining, presentation of port-site implants, management of the individual patient, and long-term outcome were analyzed. CANCERLINE and MEDLINE (1960-2002) were searched for related papers. RESULTS: Between 1993 and 2001, of the 31 patients with epithelial ovarian cancer or borderline malignancy who underwent primary laparoscopic surgery at Chang Gung Memorial Hospital, 6 (19.4%) had port-site metastasis. The other 2 patients were referred after port-site metastasis. Tumors with port-site recurrences had higher S-fraction than those without (median: 18.2% vs 9.9%, P = .003; relative risk ratio: >15.5% vs ≤ 15.5% = 38.33; 95% Cl, 3.3-449.2). Those patients who have port-site metastasis develop during chemotherapy (n = 2) or after adequate chemotherapy had been given (n = 2) all died of cancer. Two patients have been currently alive without disease, the tumors of whom were p27-positive and p53-, HER-2/neu-, bcl-2-negative. CONCLUSION: Port-site metastasis after laparoscopic surgery, during chemotherapy or when adequate chemotherapy has been given, is usually associated with poor outcome. Further investigations are necessary to define the mechanisms and effective management to prevent and treat this serious complication.