Port site metastasis (PSM) following exploratory laparoscopy (EXL) in patients with stage III-IV ovarian cancer: incidence, timing, surgical resection and morbidity.

Background: To improve the accuracy of the diagnostic work up in ovarian cancer (OC), an exploratory laparoscopy (EXL) was introduced years ago and is now accepted as an essential diagnostic tool. Beyond the clear benefits, EXL displayed an unwelcome side effect which manifested over the years: the occurrence of port site metastasis (PSM). While not a new finding after laparoscopic surgery, it has been a new occurrence to find them in patients with OC following EXL, therefore only few studies have addressed the incidence, clinical significance, treatment, and impact on survival of PSM. Objective: To investigate the incidence and timing of PSM following EXL in patients with stage III-IV OC. To report the surgical treatment needed to remove PSM, the morbidity and to test any impact on survival. Methods: From our prospectively collected OC database, we retrospectively retrieved all consecutive OC patients who underwent EXL between April 2021 and April 2023. We identified all patients with a clinically significant PSM (csPSM) diagnosed at: clinical examination, CT scan or at time of surgery. We reviewed all surgical notes, clinical notes and pathology reports and extracted: time between EXL, detection of PSM and first treatment; size of the trocars used at EXL, number and location of PSM; surgical treatment of PSM and morbidity; disease free survival. Patients were divided in upfront surgery group and interval surgery group. Results: 102 patients underwent EXL and 95 underwent debulking surgery, 52 in PDS group (51%) and 36 in IDS group (35.3%). 19 patients (18.6%) had at least 1 csPSM identified: 4 patients had 2 PSM and 1 had 3. The median time between EXL and surgery was 16 days. All patients had PSM resected at time of surgery except 6 who progressed on chemotherapy. No late complications after surgery were found in patients who experienced PSM. PSR did not contribute to R0 in all patients. At median 11.9 months follow-up, most PSM + patients did not show progression. Conclusions: Our study showed that PSM is an uncommon occurrence after EXL. Interval between diagnostic laparoscopy and surgery does not seem to affect the risk for PSM. PSM does not seem to add morbidity to debulking surgery and carries no bearing in terms of survival, routinely excision of port sites is avoidable.