Port site metastases after laparoscopic cholecystectomy

The true incidence of abdominal wall metastases after open or laparoscopic operations is unknown. The large number of reports of patients with port site metastases may represent publication bias, but there is a suspicion that recurrence of the tumour in the abdominal incision is more common after laparoscopic operations. The aetiology of port site metastases is not known but in cases of gallbladder cancer the laparoscopic handling of the tumour, perforation of the gallbladder, and extraction of the malignant specimen may be risk factors for the spread of malignant cells. These risk factors are not equally applicable in laparoscopic colorectal cancer operations in which the incidence of port site metastases seems to be lower. In addition, several other factors are probably involved in the development of such metastases, including the creation of pneumoperitoneum and the use of different gases. Laparoscopic cholecystectomy is contraindicated when gallbladder cancer is known or suspected preoperatively. When signs of malignancy are encountered during a laparoscopic operation it should be converted to an open procedure. If a gallbladder cancer is diagnosed after a completed laparoscopic operation a careful clinical follow up is indicated and if signs of recurrent malignancy develop in the port sites they should be excised, particularly as port site metastases may be the only manifestation of recurrent disease.