abstract
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.
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