Minimally invasive surgery has revolutionized the field of gynecologic surgery by offering less traumatic options to women with gynecologic tumors. Despite the benefits of this surgical approach, postoperative surgical site infections, limited mobilization, and pain still exist. In the effort to mitigate these complications and improve postoperative recovery, PSM, or postoperative structured mobility, has emerged as a promising alternative. This article explores the impact of PSM after minimally invasive surgery in gynecologic tumors, particularly in reducing morbidity, improving quality of life, and enhancing recovery outcomes.
Port site metastasis (PSM) is a rare but significant complication of minimally invasive surgery for gynecologic malignancies. PSM is defined as cancer growth at the site of a port incision after surgery. The occurrence of PSM may indicate poor prognosis for patients, especially when recurrence occurs. Despite its rarity, PSM incidence in gynecologic malignancies has been reported to be around 1-2%.
The surgical management of gynecologic tumors varies depending on the type of cancer. Laparoscopic surgery is not beneficial for ovarian cancer patients, and the incidence of PSM in ovarian cancer after diagnostic laparoscopy prior to surgery varies significantly. In contrast, minimally invasive surgery is recommended for early-stage endometrial carcinoma, and PSM is rare in patients with endometrial cancer, occurring in approximately 0.1% of such patients.
The management of PSM after robot-assisted surgery is scarce, and there are no general recommendations for their treatment, likely due to the heterogeneity and rarity of such cases. This article reports two cases of PSM after laparoscopic surgery and reviews the literature, aiming to provide the reliable incidence of PSM in the three major gynecological tumors, offer support for proposed treatment in the clinic and assess prognosis.
The first case involves a 57-year-old woman with stage IIIB high-grade serous ovarian carcinoma who underwent laparoscopic surgery. After completion of eight cycles chemotherapy, a nodule in the left inguinal region was found during regular follow-up. Surgical resection of the bilateral inguinal metastases and cytoreductive surgery were performed. The postoperative histopathologic examination revealed recurrent ovarian cancer. The patient received four cycles of PLD and carboplatin and remains under follow-up.
The second case involves a 39-year-old woman with endometrial adenocarcinoma who underwent transabdominal surgery and later laparoscopic type II radical hysterectomy. On follow-up, she was found to have a hypoechoic nodule in the right abdominal wall incision. The patient was referred to another hospital, where CT revealed an abnormal nodule in the right rectus abdominis. Surgical resection of the abdominal wall lesion revealed it to be an endometrial adenocarcinoma metastasis.
In conclusion, PSM after minimally invasive surgery for gynecologic malignancies is rare but a potential complication. Early detection of PSM can improve the prognosis of patients. However, there are no general recommendations for the management of PSM after robot-assisted surgery, likely due to the heterogeneity and rarity of such cases. Therefore, it is important to conduct further research and accumulate more cases to establish general guidelines for the management of PSM.
In conclusion, PSM is a promising method for the management of gynecologic tumors after minimally invasive surgery. With its ability to detect residual disease at an early stage, PSM can help guide further treatment decisions and improve patient outcomes. However, further studies are needed to fully evaluate its effectiveness and feasibility in clinical settings. With continued research and advancements in technology, PSM has the potential to become a valuable tool in the management of gynecologic tumors.
