Multiple Port Site Metastases After Laparoscopic Gastrectomy for Cancer
Amani Jambhekar, MD, Josue Chery, MD, Krystyna Kabata, PA, Piotr Gorecki, MD
Department of Surgery, New York Methodist Hospital, Brooklyn, New York, USA (all authors).
Introduction: Port site metastases are known phenomena associated with laparoscopic resection of intra-abdominal malignancies, but have not been well documented for gastric cancer. We report a case of port site metastases after laparoscopic subtotal gastrectomy for advanced gastric adenocarcinoma.
Case Description: A 71-year-old woman with a history of hypertension and diabetes mellitus presented with melena, weight loss, and signs of gastric outlet obstruction. Preoperative workup demonstrated a T3N1M0 mass extending along the lesser curvature of the stomach with biopsy confirming adenocarcinoma. The patient underwent an uneventful laparoscopic subtotal gastrectomy with D2 lymphadenectomy followed by adjuvant chemotherapy. Thirteen months after surgery, the patient presented with palpable subcutaneous nodules at two of the port sites. computed tomographic (CT) scan confirmed the isolated nodules without distant metastases and fine-needle aspirations confirmed gastric adenocar- cinoma. The patient was treated with another cycle of chemotherapy. A post treatment proton emission tomography (PET) scan did not show any other lesions, and the patient was scheduled for resection. During surgery the left upper quadrant mass was found to infiltrate the left colon and an additional mass was found at the prior umbilical port. Pathology was consistent with gastric adenocarcinoma for all the lesions. An excisional biopsy of the right upper quadrant lesion was completed.
Conclusion: Given the rarity of port site metastases after gastric adenocarcinoma, there is no conclusive literature regarding the management. Repeat chemotherapy followed by resection, if feasible, appears to be the most reasonable therapeutic intervention if there is no evidence of distant metastases.
Key Words: Chemotherapy, Gastric adenocarcinoma, Laparoscopic gastrectomy, Port site metastasis.