Abdominal wall recurrence after laparoscopic colectomy for colon cancer.

ABSTRACT

BACKGROUND: Although rare, abdominal wall recurrences after laparoscopic surgery for cancer have been increasing at an alarming rate as the range and sheer number of laparoscopic surgical procedures have increased. Overall, 13 case reports of abdominal wall cancer recurrence after laparoscopic surgery have been published. METHODS AND RESULTS: We present the fourth known case of abdominal wall recurrence after laparoscopic colectomy involving a patient with a TNM stage III (T3, N2, M0) colon cancer. Recurrent cancer was located in the abdominal wall incision and also in all four port sites 9 months after surgery. These four cases have all involved patients with advanced cancers of the right side of the colon who underwent a laparoscopic-assisted right hemicolectomy. These cases of abdominal wall cancer recurrence carry ominous implications for the future of laparoscopic surgical procedures involving colorectal malignancy. Recurrent cancer in minilaparotomy incisions may simply be due to local spread of cancerous cells. However, remote port site recurrence may be due to the liberation of cancer cells throughout the abdomen from advanced colorectal cancer no longer confined to the bowel wall facilitated by intraperitoneal carbon dioxide insufflation during laparoscopy. CONCLUSIONS: Abdominal wall cancer recurrence is enhanced by the laparoscopic approach to colectomy for colorectal cancer. Except for controlled, clinical studies, laparoscopic colectomy for malignancy should be abandoned.