Port-site Metastasis after Laparoscopy for Borderline Ovarian Tumor: A Case Report and Literature Review_West China Medical Journal

Authors：

 HOUQing-hua , CHENHui ,  FANGFang

Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FANGFang, Email: ffmn59@163.com

Keywords：

Port-site metastasis; Laparoscopy; Borderline ovarian tumor

DOI：

10.7507/1002-0179.20150133

Video：

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Objective To report a case of port-site metastasis (PSM) after laparoscopic treatment for borderline ovarian tumor (BOT), and to discuss the safety and efficacy of laparoscopic treatment for BOT as well as whether chemotherapy is beneficial for BOT patients. Methods We retrospectively studied a case of PSM after laparoscopic treatment of a micropapillary borderline ovarian tumor in August 2013, and reviewed the related literatures in PubMed and Cochrane databases from 1929 to 2014 using "port-site metastasis", "borderline ovarian tumor" , "laparoscopy" , "chemotherapy" as the subject words. Results After conservative operation and chemotherapy of "carboplatin and taxol" for 8 times, the subcutaneous nodes didn't shrink and the level of CA125 didn't reduce. Though some studies supported that laparoscopy was safe and effective for early-stage ovarian cancer and BOT, there was no high-quality evidence to help quantify the risks and benefits of laparoscopy for the management of early-stage ovarian cancer as routine clinical practice. While early researches suggested adjunctive chemotherapy benefited BOT patients, the subsequent studies indicated opposite results. Therefore, it was still controversial and a lack of high quality evidence existed. However, chemotherapy was recommended for those with high risks. Conclusion Laparotomy is still the standard treatment for ovarian tumor. For patients with low risks and requiring minimally invasive therapy, laparoscopy is an alternative choice, but it should be staged completely. For those with high risks or laparoscopy is difficult to perform, it should be converted to laparotomy as soon as possible. All these procedures should be completed by experienced and skillful gynecologic oncologists. For those with high risks, it is recommended that they should receive chemotherapy and be followed up for a long time.

Citation： HOUQing-hua, CHENHui, FANGFang. Port-site Metastasis after Laparoscopy for Borderline Ovarian Tumor: A Case Report and Literature Review. West China Medical Journal, 2015, 30(3): 468-472. doi: 10.7507/1002-0179.20150133 Copy

1.	Palmer R. First attempts at photocinematography during gynecological celioscopy[J]. C R Soc Fr Gyncol, 1956, 26(1):43-44.
2.	Zanetta G, Rota S, Chiari S, et al. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma:a prospective study[J]. J Clin Oncol, 2001, 19(10):2658-2664.
3.	Van Dam PA, Decloedt J, Tjalma WA, et al. Trocar implantation metastasis after laparoscopy in patients with advanced ovarian cancer:can the risk be reduced?[J]. Am J Obstet Gynecol, 1999, 181(3):536-541.
4.	Kruitwagen RF, Swinkels BM, Keyser KG, et al. Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer[J]. Gynecol Oncol, 1996, 60(2):233-237.
5.	Taylor HC. Malignant and semi-malignant tumours of the ovary[J]. Surg Gynecol Obstet, 1929, 48:204-230.
6.	FIGO. Classification and staging of malignant tumours in the female pelvis[J]. Acta Obstet Gynecol Scand, 1971, 50(1):1-7.
7.	Morice P. Borderline tumours of the ovary and fertility[J]. Eur J Cancer, 2006, 42(2):149-158.
8.	Maneo A, Vignali M, Chiari S, et al. Are borderline tumors of the ovary safely treated by laparoscopy?[J]. Gynecol Oncol, 2004, 94(2):387-392.
9.	Du Bois A, Ewald-Riegler N, Du Bois O, et al. Borderline-tumoren des ovars-eine systematische Übersicht[J]. Geburtshilfe Frauenheilkd, 2009, 69(9):807-833.
10.	Deffieux X, Morice P, Camatte S, et al. Results after laparoscopic management of serous borderline tumor of the ovary with peritoneal implants[J]. Gynecol Oncol, 2005, 97(1):84-89.
11.	Fauvet R, Boccara J, Dufournet C, et al. Laparoscopic management of borderline ovarian tumors:results of a French multicenter study[J]. Ann Oncol, 2005, 16(3):403-410.
12.	Romeo M, Pons F, Barretina P, et al. Incomplete staging surgery as a major predictor of relapse of borderline ovarian tumor[J]. World J Surg Oncol, 2013, 11:13.
13.	Trillsch F, Ruetzel JD, Herwig U, et al. Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT)[J]. J Ovarian Res, 2013, 6(1):48.
14.	Döbrönte Z, Wittmann T, Karácsony G. Rapid development of malignant metastases in the abdominal wall after laparoscopy[J]. Endoscopy, 1978, 10(2):127-130.
15.	Childers JM, Aqua KA, Surwit EA, et al. Abdominal-wall tumor implantation after laparoscopy for malignant conditions[J]. Obstet Gynecol, 1994, 84(5):765-769.
16.	Nagarsheth NP, Rahaman J, Cohen CJ, et al. The incidence of port-site metastases in gynecologic cancers[J]. JSLS, 2004, 8(2):133-139.
17.	Vergote I, Marquette S, Amant F, et al. Port-site metastases after open laparoscopy:a study in 173 patients with advanced ovarian carcinoma[J]. Int J Gynecol Cancer, 2005, 15(5):776-779.
18.	Huang KG, Wang CJ, Chang TC, et al. Management of port-site metastasis after laparoscopic surgery for ovarian cancer[J]. Am J Obstet Gynecol, 2003, 189(1):16-21.
19.	Zivanovic O, Sonoda Y, Diaz JP, et al. The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease[J]. Gynecol Oncol, 2008, 111(3):431-437.
20.	Hsiu JG, Given FT, Kemp GM. Tumor implantation after diagnostic laparoscopic biopsy of serous ovarian tumors of low malignant potential[J]. Obstet Gynecol, 1986, 68(Suppl 3):90S-93S.
21.	Gleeson NC, Nicosia SV, Mark JE, et al. Abdominal wall metastases from ovarian cancer after laparoscopy[J]. Am J Obstet Gynecol, 1993, 169(3):522-523.
22.	Shepherd JH, Carter PG, Lowe DG. Wound recurrence by implantation of a borderline ovarian tumour following laparoscopic removal[J]. Br J Obstet Gynaecol, 1994, 101(3):265-266.
23.	Wu CH, Kan YY, Changchien CC, et al. Recurrent uterine leiomyosarcoma implanted in a laparotomy scar[J]. Taiwan J Obstet Gynecol, 2008, 47(4):454-456.
24.	Lorenz U, Gassel AM, Thiede A, et al. Endometrial carcinoma recurrence in an abdominal scar 14 years after total hysterectomy[J]. Gynecol Oncol, 2004, 95(2):393-395.
25.	Ozmen B, Sükür YE, Atabekoglu CS, et al. Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer:report of two cases[J]. J Gynecol Oncol, 2011, 22(1):57-60.
26.	Ramirez PT, Frumovitz M, Wolf JK, et al. Laparoscopic port-site metastases in patients with gynecological malignancies[J]. Int J Gynecol Cancer, 2004, 14(6):1070-1077.
27.	Pearlstone DB, Feig BW, Mansfield PF. Port site recurrences after laparoscopy for malignant disease[J]. Semin Surg Oncol, 1999, 16(4):307-312.
28.	Heitz F, Ognjenovic D, Harter P, et al. Abdominal wall metastases in patients with ovarian cancer after laparoscopic surgery:incidence, risk factors, and complications[J]. Int J Gynecol Cancer, 2010, 20(1):41-46.
29.	Morice P, Camatte S, Larregain-Fournier D, et al. Port-site implantation after laparoscopic treatment of borderline ovarian tumors[J]. Obstet Gynecol, 2004, 104(5 Pt 2):1167-1170.
30.	Wang PH, Yuan CC, Lin G, et al. Risk factors contributing to early occurrence of port site metastases of laparoscopic surgery for malignancy[J]. Gynecol Oncol, 1999, 72(1):38-44.
31.	Fauvet R, Poncelet C, Daraï E. Feasibility and limits of laparoscopic treatment of borderline ovarian tumours[J]. Gynecol Obstet Fertil, 2006, 34(6):470-478.
32.	Chi DS, Abu-Rustum NR, Sonoda Y, et al. The safety and efficacy of laparoscopic surgical staging of apparent stageⅠ ovarian and fallopian tube cancers[J]. Am J Obstet Gynecol, 2005, 192(5):1614-1619.
33.	Camatte S, Morice P, Atallah D, et al. Clinical outcome after laparoscopic pure management of borderline ovarian tumors:results of a series of 34 patients[J]. Ann Oncol, 2004, 15(4):605-609.
34.	Vergote I. Role of surgery in ovarian cancer:an update[J]. Acta Chir Belg, 2004, 104(3):246-256.
35.	Lawrie TA, Medeiros LR, Rosa DD, et al. Laparoscopy versus laparotomy for FIGO stage Ⅰovarian cancer[J]. Cochrane Database Syst Rev, 2013(2):CD005344.
36.	Mettler L, Meinhold-Heerlein I. The value of laparoscopic surgery to stage gynecological cancers:present and future[J]. Minerva Ginecol, 2009, 61(4):319-337.
37.	Du Bois A, Ewald-Riegler N, De Gregorio N, et al. Borderline tumours of the ovary:a cohort study of the Arbeitsgmeinschaft Gynäkologische Onkologie (AGO) Study Group[J]. Eur J Cancer, 2013, 49(8):1905-1914.
38.	Leary A, Petrella MC, Pautier P, et al. Adjuvant platinum-based chemotherapy for borderline serous ovarian tumors with invasive implants[J]. Gynecol Oncol, 2014, 132(1):23-27.
39.	Gershenson DM, Silva EG, Levy L, et al. Ovarian serous borderline tumors with invasive peritoneal implants[J]. Cancer, 1998, 82(6):1096-1103.
40.	Gershenson DM, Silva EG, Tortolero-Luna G, et al. Serous borderline tumors of the ovary with noninvasive peritoneal implants[J]. Cancer, 1998, 83(10):2157-2163.
41.	Morgan RJ, Alvarez RD, Armstrong DK, et al. Ovarian cancer, version 2.2013[J]. J Natl Compr Canc Netw, 2013, 11(10):1199-1209.
42.	Fort MG, Pierce VK, Saigo PE, et al. Evidence for the efficacy of adjuvant therapy in epithelial ovarian tumors of low malignant potential[J]. Gynecol Oncol, 1989, 32(3):269-272.
43.	Barakat RR, Benjamin I, Lewis JL, et al. Platinum-based chemotherapy for advanced-stage serous ovarian carcinoma of low malignant potential[J]. Gynecol Oncol, 1995, 59(3):390-393.
44.	Morice P, Camatte S, Rouzier R, et al. Prognostic factors and treatment for advanced-stage borderline ovarian tumors[J]. J Gynecol Obstet Biol Reprod (Paris), 2002, 31(7):623-628.
45.	Sutton GP, Bundy BN, Omura GA, et al. Stage Ⅲ ovarian tumors of low malignant potential treated with cisplatin combination therapy (a Gynecologic Oncology Group study)[J]. Gynecol Oncol, 1991, 41(3):230-233.
46.	Shih KK, Zhou QC, Aghajanian C, et al. Patterns of recurrence and role of adjuvant chemotherapy in stage Ⅱ-Ⅳ serous ovarian borderline tumors[J]. Gynecol Oncol, 2010, 119(2):270-273.
47.	Tropé C, Kaern J, Vergote IB, et al. Are borderline tumors of the ovary overtreated both surgically and systemically? A review of four prospective randomized trials including 253 patients with borderline tumors[J]. Gynecol Oncol, 1993, 51(2):236-243.
48.	Faluyi O, Mackean M, Gourley C, et al. Interventions for the treatment of borderline ovarian tumours[J]. Cochrane Database Syst Rev, 2010(9):CD007696.
49.	Sevcík L, Klát J, Koliba P, et al. Radical surgical therapy and role of adjuvant chemotherapy in ovarian tumors of borderline malignancy[J]. Ceska Gynekol, 2004, 69(6):488-492.
50.	Burks RT, Sherman ME, Kurman RJ. Micropapillary serous carcinoma of the ovary. A distinctive low-grade carcinoma related to serous borderline tumors[J]. Am J Surg Pathol, 1996, 20(11):1319-1330.
51.	May T, Virtanen C, Sharma M, et al. Low malignant potential tumors with micropapillary features are molecularly similar to low-grade serous carcinoma of the ovary[J]. Gynecol Oncol, 2010, 117(1):9-17.
52.	Chang SJ, Ryu HS, Chang KH, et al. Prognostic significance of the micropapillary pattern in patients with serous borderline ovarian tumors[J]. Acta Obstet Gynecol Scand, 2008, 87(4):476-481.

1. Palmer R. First attempts at photocinematography during gynecological celioscopy[J]. C R Soc Fr Gyncol, 1956, 26(1):43-44.
2. Zanetta G, Rota S, Chiari S, et al. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma:a prospective study[J]. J Clin Oncol, 2001, 19(10):2658-2664.
3. Van Dam PA, Decloedt J, Tjalma WA, et al. Trocar implantation metastasis after laparoscopy in patients with advanced ovarian cancer:can the risk be reduced?[J]. Am J Obstet Gynecol, 1999, 181(3):536-541.
4. Kruitwagen RF, Swinkels BM, Keyser KG, et al. Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer[J]. Gynecol Oncol, 1996, 60(2):233-237.
5. Taylor HC. Malignant and semi-malignant tumours of the ovary[J]. Surg Gynecol Obstet, 1929, 48:204-230.
6. FIGO. Classification and staging of malignant tumours in the female pelvis[J]. Acta Obstet Gynecol Scand, 1971, 50(1):1-7.
7. Morice P. Borderline tumours of the ovary and fertility[J]. Eur J Cancer, 2006, 42(2):149-158.
8. Maneo A, Vignali M, Chiari S, et al. Are borderline tumors of the ovary safely treated by laparoscopy?[J]. Gynecol Oncol, 2004, 94(2):387-392.
9. Du Bois A, Ewald-Riegler N, Du Bois O, et al. Borderline-tumoren des ovars-eine systematische Übersicht[J]. Geburtshilfe Frauenheilkd, 2009, 69(9):807-833.
10. Deffieux X, Morice P, Camatte S, et al. Results after laparoscopic management of serous borderline tumor of the ovary with peritoneal implants[J]. Gynecol Oncol, 2005, 97(1):84-89.
11. Fauvet R, Boccara J, Dufournet C, et al. Laparoscopic management of borderline ovarian tumors:results of a French multicenter study[J]. Ann Oncol, 2005, 16(3):403-410.
12. Romeo M, Pons F, Barretina P, et al. Incomplete staging surgery as a major predictor of relapse of borderline ovarian tumor[J]. World J Surg Oncol, 2013, 11:13.
13. Trillsch F, Ruetzel JD, Herwig U, et al. Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT)[J]. J Ovarian Res, 2013, 6(1):48.
14. Döbrönte Z, Wittmann T, Karácsony G. Rapid development of malignant metastases in the abdominal wall after laparoscopy[J]. Endoscopy, 1978, 10(2):127-130.
15. Childers JM, Aqua KA, Surwit EA, et al. Abdominal-wall tumor implantation after laparoscopy for malignant conditions[J]. Obstet Gynecol, 1994, 84(5):765-769.
16. Nagarsheth NP, Rahaman J, Cohen CJ, et al. The incidence of port-site metastases in gynecologic cancers[J]. JSLS, 2004, 8(2):133-139.
17. Vergote I, Marquette S, Amant F, et al. Port-site metastases after open laparoscopy:a study in 173 patients with advanced ovarian carcinoma[J]. Int J Gynecol Cancer, 2005, 15(5):776-779.
18. Huang KG, Wang CJ, Chang TC, et al. Management of port-site metastasis after laparoscopic surgery for ovarian cancer[J]. Am J Obstet Gynecol, 2003, 189(1):16-21.
19. Zivanovic O, Sonoda Y, Diaz JP, et al. The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease[J]. Gynecol Oncol, 2008, 111(3):431-437.
20. Hsiu JG, Given FT, Kemp GM. Tumor implantation after diagnostic laparoscopic biopsy of serous ovarian tumors of low malignant potential[J]. Obstet Gynecol, 1986, 68(Suppl 3):90S-93S.
21. Gleeson NC, Nicosia SV, Mark JE, et al. Abdominal wall metastases from ovarian cancer after laparoscopy[J]. Am J Obstet Gynecol, 1993, 169(3):522-523.
22. Shepherd JH, Carter PG, Lowe DG. Wound recurrence by implantation of a borderline ovarian tumour following laparoscopic removal[J]. Br J Obstet Gynaecol, 1994, 101(3):265-266.
23. Wu CH, Kan YY, Changchien CC, et al. Recurrent uterine leiomyosarcoma implanted in a laparotomy scar[J]. Taiwan J Obstet Gynecol, 2008, 47(4):454-456.
24. Lorenz U, Gassel AM, Thiede A, et al. Endometrial carcinoma recurrence in an abdominal scar 14 years after total hysterectomy[J]. Gynecol Oncol, 2004, 95(2):393-395.
25. Ozmen B, Sükür YE, Atabekoglu CS, et al. Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer:report of two cases[J]. J Gynecol Oncol, 2011, 22(1):57-60.
26. Ramirez PT, Frumovitz M, Wolf JK, et al. Laparoscopic port-site metastases in patients with gynecological malignancies[J]. Int J Gynecol Cancer, 2004, 14(6):1070-1077.
27. Pearlstone DB, Feig BW, Mansfield PF. Port site recurrences after laparoscopy for malignant disease[J]. Semin Surg Oncol, 1999, 16(4):307-312.
28. Heitz F, Ognjenovic D, Harter P, et al. Abdominal wall metastases in patients with ovarian cancer after laparoscopic surgery:incidence, risk factors, and complications[J]. Int J Gynecol Cancer, 2010, 20(1):41-46.
29. Morice P, Camatte S, Larregain-Fournier D, et al. Port-site implantation after laparoscopic treatment of borderline ovarian tumors[J]. Obstet Gynecol, 2004, 104(5 Pt 2):1167-1170.
30. Wang PH, Yuan CC, Lin G, et al. Risk factors contributing to early occurrence of port site metastases of laparoscopic surgery for malignancy[J]. Gynecol Oncol, 1999, 72(1):38-44.
31. Fauvet R, Poncelet C, Daraï E. Feasibility and limits of laparoscopic treatment of borderline ovarian tumours[J]. Gynecol Obstet Fertil, 2006, 34(6):470-478.
32. Chi DS, Abu-Rustum NR, Sonoda Y, et al. The safety and efficacy of laparoscopic surgical staging of apparent stageⅠ ovarian and fallopian tube cancers[J]. Am J Obstet Gynecol, 2005, 192(5):1614-1619.
33. Camatte S, Morice P, Atallah D, et al. Clinical outcome after laparoscopic pure management of borderline ovarian tumors:results of a series of 34 patients[J]. Ann Oncol, 2004, 15(4):605-609.
34. Vergote I. Role of surgery in ovarian cancer:an update[J]. Acta Chir Belg, 2004, 104(3):246-256.
35. Lawrie TA, Medeiros LR, Rosa DD, et al. Laparoscopy versus laparotomy for FIGO stage Ⅰovarian cancer[J]. Cochrane Database Syst Rev, 2013(2):CD005344.
36. Mettler L, Meinhold-Heerlein I. The value of laparoscopic surgery to stage gynecological cancers:present and future[J]. Minerva Ginecol, 2009, 61(4):319-337.
37. Du Bois A, Ewald-Riegler N, De Gregorio N, et al. Borderline tumours of the ovary:a cohort study of the Arbeitsgmeinschaft Gynäkologische Onkologie (AGO) Study Group[J]. Eur J Cancer, 2013, 49(8):1905-1914.
38. Leary A, Petrella MC, Pautier P, et al. Adjuvant platinum-based chemotherapy for borderline serous ovarian tumors with invasive implants[J]. Gynecol Oncol, 2014, 132(1):23-27.
39. Gershenson DM, Silva EG, Levy L, et al. Ovarian serous borderline tumors with invasive peritoneal implants[J]. Cancer, 1998, 82(6):1096-1103.
40. Gershenson DM, Silva EG, Tortolero-Luna G, et al. Serous borderline tumors of the ovary with noninvasive peritoneal implants[J]. Cancer, 1998, 83(10):2157-2163.
41. Morgan RJ, Alvarez RD, Armstrong DK, et al. Ovarian cancer, version 2.2013[J]. J Natl Compr Canc Netw, 2013, 11(10):1199-1209.
42. Fort MG, Pierce VK, Saigo PE, et al. Evidence for the efficacy of adjuvant therapy in epithelial ovarian tumors of low malignant potential[J]. Gynecol Oncol, 1989, 32(3):269-272.
43. Barakat RR, Benjamin I, Lewis JL, et al. Platinum-based chemotherapy for advanced-stage serous ovarian carcinoma of low malignant potential[J]. Gynecol Oncol, 1995, 59(3):390-393.
44. Morice P, Camatte S, Rouzier R, et al. Prognostic factors and treatment for advanced-stage borderline ovarian tumors[J]. J Gynecol Obstet Biol Reprod (Paris), 2002, 31(7):623-628.
45. Sutton GP, Bundy BN, Omura GA, et al. Stage Ⅲ ovarian tumors of low malignant potential treated with cisplatin combination therapy (a Gynecologic Oncology Group study)[J]. Gynecol Oncol, 1991, 41(3):230-233.
46. Shih KK, Zhou QC, Aghajanian C, et al. Patterns of recurrence and role of adjuvant chemotherapy in stage Ⅱ-Ⅳ serous ovarian borderline tumors[J]. Gynecol Oncol, 2010, 119(2):270-273.
47. Tropé C, Kaern J, Vergote IB, et al. Are borderline tumors of the ovary overtreated both surgically and systemically? A review of four prospective randomized trials including 253 patients with borderline tumors[J]. Gynecol Oncol, 1993, 51(2):236-243.
48. Faluyi O, Mackean M, Gourley C, et al. Interventions for the treatment of borderline ovarian tumours[J]. Cochrane Database Syst Rev, 2010(9):CD007696.
49. Sevcík L, Klát J, Koliba P, et al. Radical surgical therapy and role of adjuvant chemotherapy in ovarian tumors of borderline malignancy[J]. Ceska Gynekol, 2004, 69(6):488-492.
50. Burks RT, Sherman ME, Kurman RJ. Micropapillary serous carcinoma of the ovary. A distinctive low-grade carcinoma related to serous borderline tumors[J]. Am J Surg Pathol, 1996, 20(11):1319-1330.
51. May T, Virtanen C, Sharma M, et al. Low malignant potential tumors with micropapillary features are molecularly similar to low-grade serous carcinoma of the ovary[J]. Gynecol Oncol, 2010, 117(1):9-17.
52. Chang SJ, Ryu HS, Chang KH, et al. Prognostic significance of the micropapillary pattern in patients with serous borderline ovarian tumors[J]. Acta Obstet Gynecol Scand, 2008, 87(4):476-481.

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