Laparoscopic hysterectomy is increasingly replacing total abdominal hysterectomy as the standard approach in the management of endometrial cancer. An uncommon but reported complication of this minimally invasive approach is the recurrence of disease at the surgical entry site, known as port- or trocar-site metastasis.
Jonathan D Grant, MD, Amit K. Garg, MD, Ramesh Gopal, MD, PhD, Pamela T. Soliman, MD, Anuja Jhingran, MD, Patricia J. Eifel, MD, Ann H. Klopp, MD, PhD; UT MD Anderson Cancer Center
Introduction: Laparoscopic hysterectomy is increasingly replacing total abdominal hysterectomy as the standard approach in the management of endometrial cancer. An uncommon but reported complication of this minimally invasive approach is the recurrence of disease at the surgical entry site, known as port- or trocar-site metastasis. The optimal management of isolated port-site metastasis is unknown, and the outcomes of very few patients with port-site metastasis have been reported in the literature. We report here on the outcome of seven patients with isolated port-site metastases who were treated definitively with or without resection and radiotherapy.
Methods: We retrospectively reviewed all cases of endometrial adenocarcinoma treated at UT MD Anderson Cancer Center from 1996–2013 who were treated with external beam radiation to the abdomen or pelvis without brachytherapy. Seven patients were identified as having isolated port-site metastases following laparoscopic surgery. Clinical and treatment characteristics were obtained from the medical chart, along with follow-up and outcome data.
Results: Patients presented with stage Ia (5), Ib (1), or II (1) endometrial cancer with endometrioid (4) or serous (3) histology. All patients underwent a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with or without a node dissection. The median interval from initial surgery to port-site recurrence was 15 months. Six of the seven patients underwent surgical resection of the recurrence, and all received radiotherapy. Patients with negative margins were treated to 45–50.4 Gy (4), one patient with a close margin (< 0.5 mm) received 60 Gy, and patients with a positive margin (1) or gross disease (1) received 66 Gy. Two patients were treated with electrons alone, three were treated with photons alone, and two received a combination of photons and electrons. Photon treatment was delivered with wedge pair (1), tangent fields (1), other conformal treatment (2), or intensity-modulated radiation therapy (IMRT) (1). Electrons were delivered appositionally with 9, 12, 18, and 16 MeV. At a median follow-up of 2 years from the time of the port-site recurrence, the rate of disease-free survival (DFS) at 1 and 2 years after the recurrence was 100% and 71%, respectively. The rate of overall survival (OS) at 2 years was 100%. One patient with stage Ia, grade 2 endometrioid adenocarcinoma developed lung metastases at 17 months following port-site recurrence. Another patient developed contralateral abdominal wall and lymph node metastases at 22 months following the recurrence.
Conclusion: High rates of DFS after definitive treatment of surgical entry-site recurrences support aggressive treatment with curative intent. The optimal integration of surgery, chemotherapy, and radiation is unknown.