INTRODUCTION: Port site metastasis (PSM) is a rare occurrence following minimally invasive treatment for renal cell carcinoma (RCC).
However, its prognostic implications are unclear because reports in the literature are heterogeneous in detail and follow-up. We sought to clarify the significance of PSM on cancer-specific survival and broaden our understanding of this phenomenon.
METHODS: A MEDLINE search for published studies of RCC PSM was performed. Contributing factors to PSM, stage, Fuhrman grade, pathology, PSM treatment method, follow-up protocol, and long-term outcomes were collected. Corresponding authors of each publication were contacted to fill in details and provide long-term outcomes. We added one case from our recent experience.
RESULTS: 16 cases from 12 authors, including ourselves, were found. Eight of the 12 authors were available for correspondence, and 9 cases were updated. Eventual outcomes were available for 11 of the 16 cases; survival curves on these showed poor prognosis with a 31.8% overall 1-year survival rate. 12 cases were radical nephrectomy, 4 were partial nephrectomy. 13/16 cases involved multiple metastases in addition to the PSM. Nine of the cases had no identifiable technical reason for PSM formation, such as specimen morcellation, absence of entrapment, or tumor rupture. These tumors were uniformly aggressive, Fuhrman grade 3 or higher.
CONCLUSIONS: PSM after minimally invasive surgery for RCC is a rare occurrence with poor prognosis. In most cases, PSM is not an isolated metastasis but is instead a harbinger of progressive disease. While technical factors can play a role in PSM formation, it appears that biological factors like high tumor grade also contribute to PSM.
Written by:
Song J, Kim E, Mobley J, Vemana G, Tanagho Y, Vetter J, Bhayani S, Russo P, Fugita O, Shei-Dei Yang S, Iwamura M, Figenshau RS. Are you the author?
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA; Memorial Sloan Kettering, New York, NY, USA; University of Sao Paulo, Sao Paulo, Brazil; En Chu Kong Hospital, Taipei, Taiwan; Kitasato University, Sagamihara, Japan.
Reference: J Urol. 2014 Feb 26. pii: S0022-5347(14)00347-4.
doi: 10.1016/j.juro.2014.02.089
PubMed Abstract
PMID: 24582771
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