title: Port-site metastases is an independent prognostic factor in patients with peritoneal carcinomatosis.
abstract: BACKGROUND
  Port-site metastases (PSMs) have been reported after laparoscopy in patients with peritoneal carcinomatosis (PC). We hypothesize that PSM is an independent negative predicting factor of survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).
  
  
  METHODS
  A retrospective review of a prospective database was conducted to search patients who underwent laparoscopy prior to CRS/HIPEC. Most of the tumors were of appendiceal origin. All previous laparoscopy port sites were excised regardless of macroscopic tumor involvement. Patients were divided into two groups: patients with PSM [PSM (+)] and patients without PSM [PSM (-)]. Overall survival (OS) was estimated by Kaplan-Meier curves and the log-rank test. Cox regression [hazard ratios (HRs) and 95 % confidence intervals (CIs)] was used to test for independent effects of the PSM (+) and the associated clinicopathological variables.
  
  
  RESULTS
  Sixty-five patients had laparoscopy before CRS/HIPEC. One hundred and forty-four port-sites were resected; 41 (29 %) ports were positive for malignancy in a total of 22 (34 %) patients. Mean OS at 1, 3, and 5 years was 88, 66, and 63 %, respectively. Survival in patients with PSM was 73, 35, and 23 %, respectively, compared with 95, 82, and 82 %, respectively, in patients without PSM (p ≤ 0.001). Positive lymph nodes (LNs) were detected in 13/22 patients with PSM and 11/43 patients without PSM. Independent effects on survival shows an HR of 3.136, 95 % CI 1.150-8.549 (p = 0.026) for LN metastases, and an HR of 3.462, 95 % CI 1.198-10.006 (p = 0.022) in patients with positive PSM.
  
  
  CONCLUSIONS
  PSMs are common in patients with PC undergoing CRS/HIPEC and are independently associated with a worse prognosis. Resection of previous laparoscopy port sites is advocated in patients with PC to ensure complete cytoreduction.
authors.affiliation: Institute for Cancer Care at Mercy Medical Center, Baltimore, MD, USA.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Nunez
authors.forename: Armando
authors.initials: A
authors.lastname: Sardi
authors.forename: William
authors.initials: W
authors.lastname: Jimenez
authors.forename: Carol
authors.initials: C
authors.lastname: Nieroda
authors.forename: Michelle
authors.initials: M
authors.lastname: Sittig
authors.forename: Ryan
authors.initials: R
authors.lastname: MacDonald
authors.forename: Nail
authors.initials: N
authors.lastname: Aydin
authors.forename: Vladimir
authors.initials: V
authors.lastname: Milovanov
authors.forename: Vadim
authors.initials: V
authors.lastname: Gushchin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult