Port-Site Metastases After Robotic Radical Cystectomy: A Systematic Review and Management Options - Beyond the Abstract

Port-site metastasis is a rare but serious complication of minimally invasive surgery. The proposed mechanism for this complication is tumor spillage during surgical procedures.

A recent study in the journal Clinical Genitourinary Cancer attempted to define the incidence of port-site metastases in patients undergoing robotic radical cystectomy. The investigators performed a systematic review of publication databases including MEDLINE and Embase to identify reports of port-site metastases after robotic radical cystectomy. They found 4 cases and reported an additional case from their own practice. As expected, all 5 patients had muscle-invasive bladder cancer cystectomy. Three patients had lymph node-positive disease. The authors concluded that the incidence of port-site metastases robotic radical cystectomy was < 0.5%. Given the small number of cases reported in the literature, this estimate is expected to change as more evidence is published.

The authors note that the incidence of port-site metastases associated with robotic radical cystectomy for bladder cancer was slightly higher than the reported incidence associated with laparoscopic surgery for combined genitourinary cancers (0.09%), prostate cancer (0.1%), and kidney cancers (0.1%). In contrast, this rate was lower when compared to robotic surgeries for gynecologic cancers (1.1% to 1.9%.).

The investigators also point out that the incidence of incision-site metastases with open cystectomy is also not well described. Systematic reporting of port-site metastases is critical to define the optimal strategies for prevention and treatment of this dreaded complication

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Author: Bishoy M. Faltas MD


Khetrapal P, Shen Tan W, Lamb B, Nathan S, Briggs T, Shankar A, Ramachandran N, Freeman A, Mitra A, Kelly JD. Port-Site Metastases After Robotic Radical Cystectomy: A Systematic Review and Management Options. Clin Genitourin Cancer. 2016 Jun 29. pii: S1558-7673(16)30163-X. doi: 10.1016/j.clgc.2016.06.012. [Epub ahead of print]