[Abdominal wall metastasis of pancreatic adenocarcinoma following laparoscopy]

Wound recurrence after oncologic surgery is known since 1885, but nowadays we deal with a new problem after the rapid diffusion of laparoscopically assisted surgery and the 22 cases of trocar site metastases already reported in literature. Aim of this paper is to present a case of cutaneous seeding of adenocarcinoma of the pancreas, in two trocar sites, after laparoscopy for lithiasis of the gallbladder. Diagnosis of neoplasia was made intraoperatively for the presence of peritoneal and omental carcinomatosis; no cholecystectomy was performed and after biopsy and postoperative TC-scan a chemotherapeutic treatment was started. Five months after the operation parietal seeding was evident and treated with local radiotherapy; the patient died one month later for further dissemination of the disease. The etiopathogenesis of tumor recurrence in the abdominal scar tissue is still unknown, local (trauma) and general (decreased immunologic defences) factors could be responsible. The apparent higher incidence after laparoscopic surgery could presuppose the presence of further specific risks: more tissue manipulation (increased cellular exfoliation), contact between trocar and abdominal wall for the whole operative period (malignant cell carrier), pneumoperitoneum. In conclusion, as 50% of the patients with cutaneous metastases die within 6 months after the operation and almost nobody is still alive after 4 years, it is necessary to establish if a real additional risk, due to the laparoscopic procedure, exists to contrast eventual benefits of the mini-invasive procedure.