UROLOGICAL SURVEY   ( Download pdf )

 

UROLOGICAL ONCOLOGY

Tumor seeding in urological laparoscopy: an international survey
Micali S, Celia A, Bove P, De Stefani S, Sighinolfi MC, Kavoussi LR, Bianchi G
Department of Urology, University of Modena e Reggio Emilia, Modena, Italy
J Urol. 2004; 171: 2151-4

  • Purpose: During the last 10 years laparoscopy has been applied to treat most urological pathology including malignancies. There has been concern regarding peritoneal dissemination and port site metastases. We undertook a survey to assess the incidence of this occurrence.
  • Materials and Methods: A total of 50 international urology departments with experts in laparoscopic urological surgery were contacted for this study. Each site was asked to complete a 2-page survey regarding the volume of laparoscopic urological procedures and port site recurrences.
  • Results: Nineteen sites elected to participate. A total of 18750 laparoscopic procedures were performed, of which 10912 were for cancer. These included 2604 radical nephrectomies, 559 nephroureterectomies, 555 partial nephrectomies, 27 segmental ureterectomies, 3665 radical prostatectomies, 1869 pelvic lymph node dissections, 479 retroperitoneal lymph node dissections, 336 adrenalectomies and 108 procedures listed as other. Tumor seeding was reported in 13 cases (0.1%), including 3 nephroureterectomies for transitional cell carcinoma, 4 nephrectomies (incidental transitional cell carcinoma), 4 adrenalectomies for metastases, 1 retroperitoneal lymph node dissection for testicular cancer and 1 pelvic lymph node dissection for cancer of the penis. Port seeding occurred in 10 cases (0.09%) and peritoneal spread in 3 cases (0.03%).
  • Conclusions: The incidence of tumor seeding after laparoscopic oncological surgery is rare and does not appear greater than what has been historically reported for open surgery. Tumor seeding seems to be most commonly related to the removal of high grade tumors and deviation from oncological surgical principles.

  • Editorial Comment
    Laparoscopic surgery has evolved to a reliable and safe procedure in urology – if indicated correctly. This paper shows the safety of the procedure in regard to oncological procedures.
    Two facts however deserve emphasis and should be kept in mind. First, patients with port metastases might not return to the surgeon or the center where the initial procedure was undertaken, so a certain number of non-reporting is certain. Second, the majority of implantation metastases (n = 7) stems from transitional cancer. This tumor entity therefore might be considered hazardous for laparoscopic procedures and open surgery might be preferable here.

Dr. Andreas Böhle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany