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682 Port site metastasis (PSM) following exploratory laparoscopy (EXL) in patients with stage III-IV ovarian cancer: incidence, timing, surgical resection and morbidity
  1. Orazio De Tommasi,
  2. Roberto Tozzi,
  3. Giulia Spagnol,
  4. Matteo Marchetti,
  5. Sofia Bigardi,
  6. Veronica Scocca,
  7. Matteo Tamagnini,
  8. Marco Noventa and
  9. Carlo Saccardi
  1. University of Padua, Padova, Italy

Abstract

Introduction/Background Ovarian cancer (OC) is the most lethal among gynecological malignancies. Exploratory laparoscopy (EXL) has proven successful in preoperatively assessing the disease extent, minimizing unnecessary laparotomies. However, the occurrence of port site metastases (PSM) following EXL is a common complication insufficiently documented, with reported rates ranging from 16% to 49%. This study focuses on investigating the incidence, timing, and outcomes of PSM in stage III-IV OC patients who underwent EXL.

Methodology From our collected database, we retrospectively retrieved all consecutive OC patients who underwent EXL between January 2009 and December 2022. We identified all patients with a PSM diagnosed at clinical examination, CT scan, or at the time of surgery.

Results Six hundred eighty-two OC patients underwent EXL, with 58 (8.5%) subsequently diagnosed with at least one PSM: 21 at the time of upfront visceral-peritoneal debulking (VPD), 24 at the post-chemotherapy scan, and 13 at the time of interval VPD. Eight patients had 2 PSM and 1 patient had 3. The average size was 3.1 cm (range 1–8 cm) and the left ancillary site was the most common location. The average time between EXL and PSM diagnosis was 18 days. Surgical treatment involved resection of fascia, subcutaneous tissue, and, if necessary, a rhomboid-shaped skin section. This approach achieved R0 resection in all cases.

Notably, PSM removal during VPD did not significantly impact disease-free survival (DFS) or overall survival (OS) over an average 52-month follow-up. Only 5 out of 58 patients (8.6%) experienced morbidity related to PSM removal.

Conclusion PSM is a complication that must be dealt with during surgery. Initiating treatment promptly after EXL may reduce PSM occurrence. Surgical removal of clinically visible PSM during VPD appears to be a well-tolerated procedure with no substantial impact on long-term prognosis.

Disclosures No.

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