Arch Gynecol Obstet DOI 10.1007/s00404-015-3734-x
LETTER TO THE EDITOR
Prevention from port-site metastasis Ali Kagan Coskun1 • Zuhal Yapici Coskun2
Received: 19 March 2015 / Accepted: 20 April 2015 Ó Springer-Verlag Berlin Heidelberg 2015
1
Department of Surgery, Gulhane Military Medical Academy, Tevfik Saglam St Etlik, 06018 Ankara, Turkey
prevention of port-site metastatic disease. In one of the review which was published by Freitas et al. [2] in 2013, they have analyzed the conditions related to port-site metastasis after laparoscopy in gynecologic malignancies. They have divided the measures into two for avoiding the development of port-site metastasis. One of them is preoperative, the other is technical. In the preoperative measures there are proper patient selection, avoidance of laparoscopic surgery in the presence of ascites, compliance guidance and adequate equipment for advanced laparoscopic surgery, knowledge of the principles of prevention in the event of intraoperative discovery of malignant disease, adequate duration of the procedure and the proper training of the surgeon [2–4]. In the technical measures, there are protected puncture of ovarian cyst, resection without rupture of an ovarian cyst, minimal tumor manipulation, resection of the tumor with adequate margin, peritoneal lavage with heparin to avoid the adhesion of free cells or lavage with cytocidal solutions, use of protective bags for tissue retrieval, avoiding CO2 leaks and sudden desufflations, use of heated and humidified CO2, exsufflation of the peritoneum before removal of the ports, drainage placement (if needed) before abdomen deflation, irrigation of the ports with heparin or povidone–iodine solution before removal, administration systematic or intraperitoneal of methotrexate, closure of all abdominal layers including the peritoneum and early chemotherapy [2, 4–9]. The authors mention some of them. But we are curious about whether in the study, application of these measures would be beneficial or not. The authors emphasized critical points about port-site metastasis. We consider that knowledge of these parameters in the study patients would be interesting to the readers.
2
Department of Obstetrics and Gynecology, Sincan State Hospital, Ankara, Turkey
Conflict of interest
Dear Editor, We read with interest the article port-site metastases in patients with gynecological cancer after robot-assisted operations by Iavazzo et al. [1] published online in Archives of Gynecology and Obstetrics. The authors analyzed robotic port-site metastasis in the field of gynecological oncology at existing literature data. They have found port-site metastasis is a rare complication of robotic surgery as it is a rather new technique with a limited time of usage Also, they have recommended additional studies to clarify port-site metastasis rates in gynecological oncology patients and to elucidate the possible mechanisms of this type of local recurrence. We notice that additional data for of the patient’s management would be beneficial if it is possible. The laparoscopic procedures for malignancies have been widely used in the last 30 years. Whether it is laparoscopic or robotic, similar complications could be seen. One of the complications of this procedure is port-site metastasis. Surgeons are trying to find an appropriate method for the
This comment refers to the article available at doi:10.1007/s00404015-3658-5 and an author’s reply to this comment is available at doi:10.1007/s00404-015-3736-8. & Ali Kagan Coskun [email protected]
None.
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Arch Gynecol Obstet
References 1. Iavazzo C, Gkegkes ID. (2015) Port-site metastases in patients with gynecological cancer after robot-assisted operations. Arch Gynecol Obstet [Epub ahead of print] 2. Freitas TO, Barbosa RM (2013) Prevention of port-site Metastasis in gynecologic malignancies. World J Laparosc Surg 6(2):77–80 3. Castillo OA, Vitagliano G (2008) Port site metastasis and tumor seeding in oncologic laparoscopic urology. Urology 71(3): 372–378 4. Agostini A, Camatte S, Farthouat P et al (2000) Port-site metastases following laparoscopic surgery. Bull Cancer 87(12): 902–906
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5. Martinez J, Targarona EM, Balague´ C et al (1995) Port site metastasis. An unresolved problem in laparoscopic surgery. A review. Int Surg 80(4):315–321 6. Ozmen B, Su¨ku¨r YE, Atabekoglu CS et al (2011) Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer: report of two cases. J Gynecol Oncol 22(1):57–60 7. Hubens G (2002) Port site metastases: where are we at the beginning of the 21st century? Acta Chir Belg 102(4):230–237 8. Hirabayashi Y, Yamaguchi K, Shiraishi N et al (2002) Development of port-site metastasis after pneumoperitoneum. Surg Endosc 16(5):864–868 9. Rane´ A, Eng MK, Keeley FX Jr (2008) Port site metastases. Curr Opin Urol 18(2):185–189
LETTER TO THE EDITOR
Prevention from port-site metastasis Ali Kagan Coskun1 • Zuhal Yapici Coskun2
Received: 19 March 2015 / Accepted: 20 April 2015 Ó Springer-Verlag Berlin Heidelberg 2015
1
Department of Surgery, Gulhane Military Medical Academy, Tevfik Saglam St Etlik, 06018 Ankara, Turkey
prevention of port-site metastatic disease. In one of the review which was published by Freitas et al. [2] in 2013, they have analyzed the conditions related to port-site metastasis after laparoscopy in gynecologic malignancies. They have divided the measures into two for avoiding the development of port-site metastasis. One of them is preoperative, the other is technical. In the preoperative measures there are proper patient selection, avoidance of laparoscopic surgery in the presence of ascites, compliance guidance and adequate equipment for advanced laparoscopic surgery, knowledge of the principles of prevention in the event of intraoperative discovery of malignant disease, adequate duration of the procedure and the proper training of the surgeon [2–4]. In the technical measures, there are protected puncture of ovarian cyst, resection without rupture of an ovarian cyst, minimal tumor manipulation, resection of the tumor with adequate margin, peritoneal lavage with heparin to avoid the adhesion of free cells or lavage with cytocidal solutions, use of protective bags for tissue retrieval, avoiding CO2 leaks and sudden desufflations, use of heated and humidified CO2, exsufflation of the peritoneum before removal of the ports, drainage placement (if needed) before abdomen deflation, irrigation of the ports with heparin or povidone–iodine solution before removal, administration systematic or intraperitoneal of methotrexate, closure of all abdominal layers including the peritoneum and early chemotherapy [2, 4–9]. The authors mention some of them. But we are curious about whether in the study, application of these measures would be beneficial or not. The authors emphasized critical points about port-site metastasis. We consider that knowledge of these parameters in the study patients would be interesting to the readers.
2
Department of Obstetrics and Gynecology, Sincan State Hospital, Ankara, Turkey
Conflict of interest
Dear Editor, We read with interest the article port-site metastases in patients with gynecological cancer after robot-assisted operations by Iavazzo et al. [1] published online in Archives of Gynecology and Obstetrics. The authors analyzed robotic port-site metastasis in the field of gynecological oncology at existing literature data. They have found port-site metastasis is a rare complication of robotic surgery as it is a rather new technique with a limited time of usage Also, they have recommended additional studies to clarify port-site metastasis rates in gynecological oncology patients and to elucidate the possible mechanisms of this type of local recurrence. We notice that additional data for of the patient’s management would be beneficial if it is possible. The laparoscopic procedures for malignancies have been widely used in the last 30 years. Whether it is laparoscopic or robotic, similar complications could be seen. One of the complications of this procedure is port-site metastasis. Surgeons are trying to find an appropriate method for the
This comment refers to the article available at doi:10.1007/s00404015-3658-5 and an author’s reply to this comment is available at doi:10.1007/s00404-015-3736-8. & Ali Kagan Coskun [email protected]
None.
123
Arch Gynecol Obstet
References 1. Iavazzo C, Gkegkes ID. (2015) Port-site metastases in patients with gynecological cancer after robot-assisted operations. Arch Gynecol Obstet [Epub ahead of print] 2. Freitas TO, Barbosa RM (2013) Prevention of port-site Metastasis in gynecologic malignancies. World J Laparosc Surg 6(2):77–80 3. Castillo OA, Vitagliano G (2008) Port site metastasis and tumor seeding in oncologic laparoscopic urology. Urology 71(3): 372–378 4. Agostini A, Camatte S, Farthouat P et al (2000) Port-site metastases following laparoscopic surgery. Bull Cancer 87(12): 902–906
123
5. Martinez J, Targarona EM, Balague´ C et al (1995) Port site metastasis. An unresolved problem in laparoscopic surgery. A review. Int Surg 80(4):315–321 6. Ozmen B, Su¨ku¨r YE, Atabekoglu CS et al (2011) Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer: report of two cases. J Gynecol Oncol 22(1):57–60 7. Hubens G (2002) Port site metastases: where are we at the beginning of the 21st century? Acta Chir Belg 102(4):230–237 8. Hirabayashi Y, Yamaguchi K, Shiraishi N et al (2002) Development of port-site metastasis after pneumoperitoneum. Surg Endosc 16(5):864–868 9. Rane´ A, Eng MK, Keeley FX Jr (2008) Port site metastases. Curr Opin Urol 18(2):185–189
