Abdominal-Wall Tumor Implantation Following Laparoscopic for Malignant Conditions

To determine the incidence of abdominal-wall tumor implantation following laparoscopic procedures in patients with known malignancies, we reviewed 550 laparoscopic procedures performed on the Gynecologic Oncology Service between November 1990 and December 1993. In 100 procedures malignancy was documented cytologically or histologically, 84 with intraperitoneal and 16 with retroperitoneal disease. Ovarian cancer comprised 80% (67/84) of the procedures with intraperitoneal malignancy; the remainder consisted of fallopian tube (2), endometrial (11), cervical (1), breast (2), and gastric (1) carcinomas. Except for a recurrent squamous cell carcinoma of the cervix, all intraperitoneal carcinomas were adenocarcinomas. Four hundred twenty-three different abdominal-wall puncture sites were used, 37 Veress needle sites, and 386 laparoscopic ports. One of the 423 (0.2%) abdominal-wall puncture sites developed an implantation, for an incidence of 1.0% (1/100) per procedure. This developed after a second-look laparoscopic procedure for ovarian carcinoma in which only microscopic disease was present. If just intraperitoneal disease is considered, the incidence of implantation was 0.3% (1/351) per abdominal puncture and 1.2% (1/84) per procedure. No port site that was irrigated developed implantation. We concluded that abdominal-wall tumor implantation at the abdominal-wall puncture site is an infrequent occurrence after laparoscopy in patients with intraperitoneal and retroperitoneal carcinoma.