Regional lymph node metastasis from port site implants after laparoscopic surgery

Area of Science:

• Surgical Oncology
• Gastroenterology
• Pathology

Background:

• Laparoscopic surgery is common, but port site implantation of malignant cells remains a concern, especially with undetected intraabdominal cancers.
• Port-site metastases can act as secondary seeding sites for further cancer dissemination.
• Occult intraabdominal malignancy poses a risk for port-site metastasis during laparoscopic procedures.

Observation:

• A patient who underwent laparoscopic cholecystectomy for gallstones developed right colon cancer one month later.
• Eleven months post-surgery, CT scans revealed nodules at an original laparoscopic port site (umbilicus) and near the deep epigastric vessels.
• Histopathology confirmed metastatic adenocarcinoma at both sites, with the deep epigastric nodule being lymph node-positive.

Findings:

• Metastatic adenocarcinoma was confirmed at both the umbilical port site and the deep epigastric lymph node.
• The deep epigastric lymph node metastasis likely originated from the port site implant, indicating cancer cell spread.
• This case highlights the potential for port site metastases to lead to regional lymph node involvement.

Implications:

• The study suggests that cancer cells can disseminate from laparoscopic port sites to regional lymph nodes in the abdominal wall.
• It is recommended to investigate lymph nodes draining the abdominal wall in all patients presenting with port site implants.
• This finding underscores the importance of meticulous surgical technique and awareness of potential oncologic risks in laparoscopic surgery.