Prognostic Impact of Port-Site Metastasis After Diagnostic Laparoscopy for Epithelial Ovarian Cancer

• Published in: Annals of surgical oncology Vol. 23; no. Suppl 5; pp. 834 - 840
• Main Authors: Ataseven, Beyhan, Grimm, Christoph, Harter, Philipp, Heikaus, Sebastian, Heitz, Florian, Traut, Alexander, Prader, Sonia, Kahl, Annett, Schneider, Stefanie, Kurzeder, Christian, du Bois, Andreas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2016; Springer Nature B.V
• Subjects: Aged; Ascites - complications; Cytoreduction Surgical Procedures; Female; Gynecologic Oncology; Humans; Laparoscopy - adverse effects; Lymphatic Metastasis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Seeding; Neoplasm Staging; Neoplasm, Residual; Neoplasms, Glandular and Epithelial - secondary; Neoplasms, Glandular and Epithelial - surgery; Oncology; Ovarian cancer; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Pleural Effusion, Malignant - etiology; Risk Factors; Surgery; Surgical Oncology; Surgical Wound - etiology; Surgical Wound - pathology; Surgical Wound - surgery; Survival Rate; Wound Healing; Epithelial Ovarian Cancer; Epithelial Ovarian Cancer Patient; High Tumor Stage; Malignant Pleural Effusion; Positive Lymph Node Status
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5415-9

Background
This study was designed to evaluate the prevalence, morbidity, and prognostic impact of port-site metastasis (PSM) in patients with epithelial ovarian cancer (EOC) undergoing laparoscopy before subsequent primary debulking surgery (PDS).
Methods
All consecutive patients treated between 2000 and 2014, who had a laparoscopy followed by PDS, were extracted from our prospectively maintained database. All patients with histological examination of port-sites were included in this unicentric exploratory analysis.
Results
A total of 250 (25.5 %) of 982 patients with EOC underwent laparoscopy before PDS. Port-site resection was performed in those 214 (85.6 %) patients in whom a complete or almost complete resection with residuals ≤1 cm was achieved. Median interval between laparoscopy and PDS was 25 days. PSM was detected in 100 of 214 patients (46.7 %). Risk factors for PSM were higher tumor stage (odds ratio [OR] 13.5, 95 % confidence interval [CI] 2.9–62.0,
p
 = 0.04), positive lymph node status (OR 3.0, 95 % CI 1.3–6.7,
p
 = 0.009), and ascites >500 mL (OR 3.9, 95 % CI 1.5–10.0,
p
 = 0.005). Wound healing disorders and postoperative morbidity were significantly higher in patients with PSM (Clavien–Dindo Classification grade 3–5: 41.0 vs. 14.9 %,
p
 < 0.001). However, multivariate Cox-regression models did not identify PSM as independent prognostic factor.
Conclusions
The prevalence of PSM after laparoscopy in EOC patients is considerably high. PSM had no impact on survival; however, PSM were associated with more postoperative complications and a higher surgical treatment burden. This should be balanced with the expected benefit when laparoscopy is considered for the management of EOC.