An unusual case of port site seeding

We present an unusual case of a port site tumor from a colonic adenocarcinoma following laparoscopic cholecystectomy. A 66-year-old woman with a previous renal transplant underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis. Three months later, she re-presented with pain localized to the right lateral port wound. Subsequent investigation revealed an adenocarcinoma in the ascending colon with no evidence of local spread or liver metastases. The patient was enrolled in the ALCCAS trial (an Australasian multicenter prospective randomized clinical study comparing laparoscopic and conventional open surgical treatments of colon cancer in adults) and randomized to the laparoscopic arm. At laparoscopy, nodules of tumor were located at the sites of the previous right flank and umbilical trocar sites. The procedure was converted to an open hemicolectomy with excision of port sites. To our knowledge, only one other case of a colon carcinoma metastasizing to a port site following laparoscopic cholecystectomy has been reported. This case illustrates a number of points: (a) This was an advanced tumor at the time of diagnosis and was undoubtedly present at laparoscopic cholecystectomy. (b) This tumor was not manipulated at the time of laparoscopic cholecystectomy. (c) The patient was immunosuppressed at the time of laparoscopic cholecytstectomy. (d) The patient developed clinical recurrence in her laparotomy wound within 3 months of her open procedure. This case supports current arguments that the etiology of port site metastases is likely to be mulifactorial.