title: Port-Site Metastases After Robotic Radical Cystectomy: A Systematic Review and Management Options.
abstract: Port-site metastases (PSMs) are a rare occurrence after robotic surgery. For robot-assisted radical cystectomy (RARC), isolated cases have been reported but management has not been previously described. We present a case of PSM that occurred after RARC and report the results of our systematic review of previously reported PSMs and describe the treatment options. Search Criteria and Methods: We describe a case of a PSM in a 55-year-old man who had undergone intracorporeal RARC. We performed a systematic review of MEDLINE and Embase databases for previously reported PSMs, detailing the stage and grade of the primary tumor, time to presentation of PSM, treatment offered, and outcomes for the identified cases.
  
  
  
  We identified 4 cases of PSMs after RARC in published studies and also included our case for analysis. All 5 patients had muscle-invasive bladder cancer at cystectomy (stage ≥ T2) and 3 had local lymph node-positive disease. Our aggressive treatment of chemotherapy, wide surgical excision of PSM, and radiotherapy provided our patient with a 2-year disease-free status.
  
  
  
  PSMs are a rare event in RARC, with only 4 other cases reported in published studies. The outcomes have not been well reported for these cases. We propose that multimodality treatment consisting of salvage chemotherapy, surgery, and radiotherapy should be considered, although concessions could be needed after consideration of patient factors.
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK. Electronic address: p.khetrapal@ucl.ac.uk.
authors.forename: Pramit
authors.initials: P
authors.lastname: Khetrapal
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Tan
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lamb
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Senthil
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Briggs
authors.affiliation: Department of General Surgery, University College London Hospital, London, UK.
authors.forename: Arjun
authors.initials: A
authors.lastname: Shankar
authors.affiliation: Department of Radiology, University College London Hospital, London, UK.
authors.forename: Navin
authors.initials: N
authors.lastname: Ramachandran
authors.affiliation: Department of Histopathology, University College London Hospital, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.affiliation: Department of Oncology, University College London Hospital, London, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Mitra
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Kelly
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Bladder cancer; Cystectomy; Multi-modality treatment; Port-site metastasis; Rare complications