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PORT SITE RECURRENCE AFTER LAPAROSCOPIC RESECTION OF RETROPERITONEAL LIPOSARCOMA
Vol. 159,1296-1297, April 1998 Printed in U S &
PORT SITE RECURRENCE AFTER LAPAROSCOPIC RESECTION OF RETROPERITONEAL LIPOSARCOMA AKIO HORIGUCHI,* SHIRO SAITO, SHIRO BABA, MASARU MURAI
AND
MAKIO MUKAI
From the Departments of Urology and Diagnostic Pathology, School of Medicine, Keio University, Tokyo, Japan KEY WORDS:recurrence, laparoscopy, liposarcoma
Laparoscopic surgery is minimally invasive and becoming a more common procedure in urology. We report a case of port site metastasis after laparoscopy assisted surgery for retroperitoneal liposarcoma and discuss a limitation of laparoscopic surgery for tumor resection. CASE REPORT
A 53-year-old woman presented with a retroperitoneal tumor below the right kidney which was revealed on computerized tomography (CT)and clinically diagnosed as schwanAccepted for publication September 5, 1997. * F k g e s t s for reprinta: Department of Urolo School of Medi10 Umversity, 35 Shinanomachi, Shinjgh-ku, Tokyo 160, cine, Japan.
noma (fig. 1, A). The tumor, which was resected by laparoscopy assisted surgery using 5 ports, was found just behind the cecum, trapped in a plastic sac and removed through an additional pararectal incision. The surgical specimen weighed 380 gm. and measured 10 X 10 X 7.5 cm. Histologically, the tumor was diagnosed as myxoid liposarcoma (fig. 1,B).At 2-year followup a subcutaneous mass was palpable at the right lower abdominal wall. CT revealed a tumor at the laparoscopic port site (fig. 2, A). NO other metastasis or local recurrence was found. An incision was made above the tumor, which was under the external abdominal oblique muscle and did not extend to the transversalis fascia. The tumor was adherent strongly to the abdominal fascia and severe scars had formed around the tumor, suggesting that it had grown at a port site of the previous laparoscopic operation. Abdominal fascia was partially resected with the
A
FIG. 1. A, CT demonstrates low density mass, which was well detined and heterogenous. Findin s were highly suggestive of retroperitoneal schwannoma. B, histovogicall tumor was composed of FIG. 2. A, CT demonstrates heterogeneous abdominal wall tumor myxoid matrix, prominent capillary vessefs and primitive mesenchy- (arrow). B, abdominal tumor was histologically diagnosed as myxoid mal cells. Few scattered lipoblasts were found (arrow). H & E, liposarcoma, which was composed of prominent myxoid matrix and reduced from ~ 7 5 . few scattered lipoblasts (arrow). H & E, reduced from X75. 1296
PORT SITE RECURRENCE AFTER LAPAROSCOPIC RESECTION OF LIPOSARCOMA
tumor at the adhesion site. The tumor was histologically diagnosed as myxoid liposarcoma (fig. 2, B ) . DISCUSSI 0 N
Laparoscopic surgery is a minimally invasive treatment, which can be used for tumor resection. Despite the enthusiasm for this technique some new complications have been reported, such as port site recurrence following the resection of malignant tumors. Since the first laparoscopic cholecystectomy, more than 100 port site metastases of unexpected gallbladder cancer have been reported.' Similiar cases have been reported in gynecological laparoscopic surgery for ovarian tumor and urological surgery for pelvic lymphadenectomy of bladder and prostate cancer.1.2 A possible mecha-
1297
nism for port site cell implantation is a lengthy operative procedure with high pressure pneumoperitoneum, which enables the tumor cell to implant locally or disseminate hematogeneously during the operation.' Laparoscopic surgery may be widely applied to retroperitoneal tumors but malignant tumors should be excised carefully to avoid unexpected complications, such as occurred in our case. REFERENCES
1. Martinez,J.,Targarona, E. M., Balague, C., Pera, M. and Was, M.: Port site metastasis. An unresolved problem in laparoscopic surgery. A review. Int. Surg., 80: 315,1995. 2. Bangma, C.H., Kirkels, W. J., Chadha, S. and Schroder, F. H.: Cutaneous metastasis following laparoscopic pelvic lymphadenectomy for prostatic carcinoma. J. Urol., 153: 1635,1995.
PORT SITE RECURRENCE AFTER LAPAROSCOPIC RESECTION OF RETROPERITONEAL LIPOSARCOMA AKIO HORIGUCHI,* SHIRO SAITO, SHIRO BABA, MASARU MURAI
AND
MAKIO MUKAI
From the Departments of Urology and Diagnostic Pathology, School of Medicine, Keio University, Tokyo, Japan KEY WORDS:recurrence, laparoscopy, liposarcoma
Laparoscopic surgery is minimally invasive and becoming a more common procedure in urology. We report a case of port site metastasis after laparoscopy assisted surgery for retroperitoneal liposarcoma and discuss a limitation of laparoscopic surgery for tumor resection. CASE REPORT
A 53-year-old woman presented with a retroperitoneal tumor below the right kidney which was revealed on computerized tomography (CT)and clinically diagnosed as schwanAccepted for publication September 5, 1997. * F k g e s t s for reprinta: Department of Urolo School of Medi10 Umversity, 35 Shinanomachi, Shinjgh-ku, Tokyo 160, cine, Japan.
noma (fig. 1, A). The tumor, which was resected by laparoscopy assisted surgery using 5 ports, was found just behind the cecum, trapped in a plastic sac and removed through an additional pararectal incision. The surgical specimen weighed 380 gm. and measured 10 X 10 X 7.5 cm. Histologically, the tumor was diagnosed as myxoid liposarcoma (fig. 1,B).At 2-year followup a subcutaneous mass was palpable at the right lower abdominal wall. CT revealed a tumor at the laparoscopic port site (fig. 2, A). NO other metastasis or local recurrence was found. An incision was made above the tumor, which was under the external abdominal oblique muscle and did not extend to the transversalis fascia. The tumor was adherent strongly to the abdominal fascia and severe scars had formed around the tumor, suggesting that it had grown at a port site of the previous laparoscopic operation. Abdominal fascia was partially resected with the
A
FIG. 1. A, CT demonstrates low density mass, which was well detined and heterogenous. Findin s were highly suggestive of retroperitoneal schwannoma. B, histovogicall tumor was composed of FIG. 2. A, CT demonstrates heterogeneous abdominal wall tumor myxoid matrix, prominent capillary vessefs and primitive mesenchy- (arrow). B, abdominal tumor was histologically diagnosed as myxoid mal cells. Few scattered lipoblasts were found (arrow). H & E, liposarcoma, which was composed of prominent myxoid matrix and reduced from ~ 7 5 . few scattered lipoblasts (arrow). H & E, reduced from X75. 1296
PORT SITE RECURRENCE AFTER LAPAROSCOPIC RESECTION OF LIPOSARCOMA
tumor at the adhesion site. The tumor was histologically diagnosed as myxoid liposarcoma (fig. 2, B ) . DISCUSSI 0 N
Laparoscopic surgery is a minimally invasive treatment, which can be used for tumor resection. Despite the enthusiasm for this technique some new complications have been reported, such as port site recurrence following the resection of malignant tumors. Since the first laparoscopic cholecystectomy, more than 100 port site metastases of unexpected gallbladder cancer have been reported.' Similiar cases have been reported in gynecological laparoscopic surgery for ovarian tumor and urological surgery for pelvic lymphadenectomy of bladder and prostate cancer.1.2 A possible mecha-
1297
nism for port site cell implantation is a lengthy operative procedure with high pressure pneumoperitoneum, which enables the tumor cell to implant locally or disseminate hematogeneously during the operation.' Laparoscopic surgery may be widely applied to retroperitoneal tumors but malignant tumors should be excised carefully to avoid unexpected complications, such as occurred in our case. REFERENCES
1. Martinez,J.,Targarona, E. M., Balague, C., Pera, M. and Was, M.: Port site metastasis. An unresolved problem in laparoscopic surgery. A review. Int. Surg., 80: 315,1995. 2. Bangma, C.H., Kirkels, W. J., Chadha, S. and Schroder, F. H.: Cutaneous metastasis following laparoscopic pelvic lymphadenectomy for prostatic carcinoma. J. Urol., 153: 1635,1995.