Port-site metastases: Fact or fiction?

The phenomenon of port-site metastases, especially in the areas of gynecology and visceral surgery, has for some time overshadowed the discussion concerning the benefit and implementation of laparoscopic surgical techniques in the treatment of malignant disease. What is rather typical in urology, e.g. a small number of cases, and the fact that the development of laparoscopic techniques usually takes place in referral centers, has meant that this discussion has either not taken place at all in urology or has only taken place at a marginal level. The initial reports which triggered the discussion showed that rather deficient methods had been used, e.g. animal studies were carried out under unrealistic conditions. All data without exception have been refuted. Current publications confirm that the incidence of port-site metastases after laparoscopic surgery is comparable with that after open surgery. Several prospective studies have found out that laparoscopic surgery performed on colorectal carcinomas in stages I-III even had a 20% better survival rate when compared with conventional techniques. To what extent these data will be confirmed in the long run remains to be seen. The issue does however merit attention. At present, the discussion concerning the phenomenon of port-site metastases has to be reconsidered. In the meantime, the initial alarming reports in the literature have given way to a great deal of credible data on the absolute comparability of laparoscopic and conventional open surgery in terms of port-site metastases. Port-site metastases do occur in a small percentage of patients both after laparoscopy and after open surgery.