title: Camera-port site metastasis of a renal-cell carcinoma after robot-assisted partial nephrectomy.
abstract: OBJECTIVE
  Port-site metastasis (PSM) is a rare complication of laparoscopic intervention in urologic malignancies. Of the greater than 50 reported cases of PSM in the urologic oncology literature, only 9 have occurred after surgery for renal-cell carcinoma (RCC). We report a 10th instance of RCC metastasis-in this case to the camera-port site after robot-assisted partial nephrectomy (RAPN). To our knowledge, this case is the first reported PSM of RCC after RAPN.
  
  
  METHODS
  A 68-year-old man underwent an uncomplicated right RAPN for a 4-cm right renal mass (stage T1aN0M0). Five months later, he was found to have metastatic disease with an isolated peritoneal recurrence at the camera-port site. Biopsy of the lesion confirmed RCC, and the lesion was surgically resected. A comprehensive MEDLINE search for all published studies of port-site recurrences after laparoscopic renal surgery for RCC was performed.
  
  
  RESULTS
  Nine cases of PSM after successful laparoscopic radical or partial nephrectomy for locally confined RCC have been reported. Proposed etiologic factors for port-site recurrence include biologic aggressiveness of the tumor, patient immunosuppression, local wound factors, and technique-related factors. We report an unusual case of PSM to a camera port that was not used for specimen manipulation or extraction.
  
  
  CONCLUSIONS
  PSM after laparoscopic renal surgery for RCC is a rare occurrence. Our case, in which PSM occurred without specimen bag rupture or extraction through the port in question, highlights the importance of local and systemic factors in contributing to PSM occurrence. We also demonstrate that when PSM is the only site of disease recurrence, it can be successfully managed with minimally invasive surgical resection.
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Song
authors.forename: Youssef S
authors.initials: YS
authors.lastname: Tanagho
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kim
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Abbosh
authors.forename: Goutham
authors.initials: G
authors.lastname: Vemana
authors.forename: R Sherburne
authors.initials: RS
authors.lastname: Figenshau
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D009366:Neoplasm Seeding; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D012371:Robotics