婦人科腫瘍学における腹腔鏡手術後のポートサイト転移の病態と起こりうる結果

Port-site metastasis (PSM) is an infrequent and serious complication of laparoscopic treatment. The incidence of PSM is 0.16-2.3% of patients undergoing laparoscopic surgery for gynecologic malignancies. Depending on the place of origin of the malignant tumor, PSM appears on average the earliest after ovarian cancer treatment and the latest after vaginal cancer surgery. To date, several important risk factors have been identified. Hypotheses such as wound contamination, hematogenous and lymphatic spread, immune response and CO2 pneumoperitoneum have been formulated as possible agents influencing the occurrence of PSM. Overall survival (OS) is a particularly important issue from the standpoint of the person performing the procedure and the patient. OS may be influenced by the histological type of cancer, its origin in the body, the method of treatment, as well as the type of PSM and the time of its occurrence after the end of therapy. Patients with PSM require local or systemic treatment, as well as consideration of complementary therapy. There are theories indicating that appropriate preoperative management in patients with gynecological malignancies can prevent the occurrence of PSM. Despite enormous laparoscopy development over the last 20 years, a complication such as PSM still leaves many unknowns and therefore causes difficulties in therapeutic procedures. Each patient should be closely monitored before and after the laparoscopic procedure to exclude potential factors for the occurrence of PSM and its possible post-procedure diagnosis. Moreover, it is the responsibility of the person performing laparoscopy to accomplish the procedure as precisely as possible to minimize the risk of this complication. The main aim of the following review is to present the phenomenon of PSM in gynecologic oncology, its epidemiology, pathogenesis and possible consequences for the prognosis of the patient.