Port-site metastasis: the influence of biology.
OBJECTIVE
Several surgical and technical mechanisms have been proposed for the development of port-site metastasis, but the influence of tumor and host biologic factors has not been emphasized. We present a case of a pelvic chordoma that metastasized to a prior laparoscopic radical nephrectomy port-site.


METHODS
A 62-year-old woman underwent laparoscopic radical nephrectomy (LRN) for a pT1b grade 3 renal cell carcinoma, followed 6 weeks later by resection of a sacral chordoma. The incisions and areas of dissection for the two procedures were discontinuous.


RESULTS
Eight months following the LRN she developed a nodule in one of the laparoscopic port-sites. The port-site metastasis was treated with wide surgical resection, which was confirmed as metastatic chordoma on histologic examination.


CONCLUSIONS
Based on the chronological sequence and physical distance between surgical sites, only biological factors could have contributed to this port-site metastasis. This unusual case highlights the important role that tumor and host biologic mechanisms play in the development of port-site metastasis.
Highshaw
Ralph A
RA
Department of Urology, University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Vakar-Lopez
Funda
F
Jonasch
Eric
E
Yasko
Alan W
AW
Matin
Surena F
SF
D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D002817:Chordoma / Q000209:etiology / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009366:Neoplasm Seeding; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000601:surgery; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D010388:Pelvis / Q000601:surgery; D012187:Retroperitoneal Space / Q000601:surgery