GYN/OB-2. Port site metastasis remote from the time of initial laparoscopy.

With the increased usage of laparoscopy in gynecologic surgery over the past 10 years, a number of ovarian carcinomas have been first diagnosed at the time of laparoscopy. As this number continues to rise, it is important to recognize both the associated short- and long-term complications. A 54-year-old white female was initially diagnosed with stage IIIC ovarian adenocarcinoma at laparoscopy in May 2001. She immediately underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, rectosigmoid resection, and descending end colostomy with Hartmann's pouch formation. She received carboplatin and cyclophosphamide with a partial response noted. Gemzar and Doxil were added yielding a complete clinical response. In June 2002, the patient underwent a colostomy reversal with no evidence of disease at surgery. In October 2002 the patient was found by CT scan to have recurrent disease involving retroperitoneal lymph nodes, a mass in the left hemipelvis, and the liver. She began topotecan therapy. In January 2003, 20 months after her initial laparoscopy, the patient was noted to have a new mass growing out of the prior umbilical port site. Pathology following surgical resection revealed the mass to be consistent with ovarian adenocarcinoma. Laparoscopy has become an important and commonly used diagnostic tool of the gynecologic surgeon. Its use at initial surgical diagnosis of ovarian carcinoma is occasionally associated with port site recurrences, usually identified only days to weeks later. It is unusual to see a port site recurrence remote from the time of laparoscopy, after a complete response to therapy. This case serves to heighten the gynecologic oncologist's awareness of the possibility of delayed port site recurrence even in patients with prior complete response to chemotherapy.

Olivia J. McCallum, MD, James J. Burke II, MD, Alex Ferro, MD, Donald G. Gallup, MD. Department of Obstetrics and Gynecology, Mercer University School of Medicine, Savannah, GA. Memorial Health University Medical Center, Savannah, GA.