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Liu X, Yu H, Zhao J, Di X, Wang J, Zhang H. Iodine-125 Brachytherapy for Palliative Treatment of Painful Colorectal Cancer Port-Site Metastases. J Gastrointest Cancer 2024; 55:198-201. [PMID: 37889435 DOI: 10.1007/s12029-023-00978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To summarize the treatment process of a case of Iodine-125 Brachytherapy for Palliative Treatment of Painful Colorectal Cancer Port-Site Metastases. METHODS We present a case report of multifocal port-site metastases ( PSMs ) that developed in a patient with stage IV ascending colonic adenocarcinoma and mucinous cancer following laparoscopic surgery. After multiline therapy failed, painful PSMs treated with repeated iodine-125 seed implantation. RESULTS Severe abdominal discomfort were eventually successfully managed after receiving iodine-125 brachytherapy. CONCLUSION For painful PSMs, iodine-125 brachytherapy can be a safe and effective treatment option.
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Affiliation(s)
- Xiaoli Liu
- Department of Oncology, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Huimin Yu
- Department of Oncology, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Jinxin Zhao
- Department of Oncology, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Xuemin Di
- Department of Oncology, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Juan Wang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Hongtao Zhang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, 050000, China.
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Yu N, Zhou T, Sun H, Fu P, Liu R. Port Site Metastasis After Minimally Invasive Surgery in Gynecologic Malignancies: Two Case Reports and a Review of the Literature. Int J Womens Health 2023; 15:579-588. [PMID: 37077283 PMCID: PMC10106789 DOI: 10.2147/ijwh.s406488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
Port site metastasis (PSM) is considered an uncommon and rare complication in gynecologic malignancies with unclear treatment recommendations or guidelines. Thus, we report the treatment strategies and outcomes of two cases of PSMs following gynecologic malignancies and a review of the literature to provide much information about the most frequent sites of PSMs and the incidence of PSMs in different gynecological tumors. A 57-year-old woman underwent laparoscopic radical surgery for right ovarian serous carcinoma in June 2016 followed by postoperative chemotherapy. Because PSMs were present near the port site of the bilateral iliac fossa, the tumors were completely removed on August 4, 2020, and the patient received chemotherapy. She has shown no signs of relapse. During the same period, a 39-year-old woman underwent laparoscopic type II radical hysterectomy for endometrial adenocarcinoma involving the endometrium and cervix on May 4, 2014, without adjuvant treatment. In July 2020, a subcutaneous mass under her abdominal incision was removed, and chemotherapy plus radiotherapy was administered. Metastasis was found in the left lung in September 2022, but there was no abnormality in the abdominal incision. We showed the two cases of PSMs, reviewed articles to provide some new insights about the incidences of PSMs in the gynecologic tumors, and discussed the proper preventive strategies.
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Affiliation(s)
- Nan Yu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Peiying Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Ronghua Liu, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv., Wuhan, Hubei, 430030, People’s Republic of China, Tel +86-27-63639807, Fax +86 (27) 83663078, Email
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Brandt B, Levin G, Leitao MM. Radical Hysterectomy for Cervical Cancer: the Right Surgical Approach. Curr Treat Options Oncol 2022; 23:1-14. [PMID: 35167007 DOI: 10.1007/s11864-021-00919-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Radical hysterectomy with pelvic lymph node assessment is the standard initial therapy for early-stage cervical cancer. Radical hysterectomy via laparotomy (an "open" approach) was first described more than 100 years ago and has been the standard for decades. Minimally invasive surgery (MIS) has been increasingly adopted by many surgeons due to its reported perioperative benefits. MIS was deemed safe for radical hysterectomy for many years based on multiple retrospective publications. Recently, the Laparoscopic Approach to Cervical Cancer (LACC) trial reported that patients randomized to MIS had inferior oncologic outcomes. The results of the LACC trial and subsequent retrospective studies led multiple professional societies to state that open radical hysterectomy should remain the gold standard surgical approach. We acknowledge that the open approach for radical hysterectomy is an appropriate option for all cervical cancer patients eligible for surgical treatment. However, considering the limitations of the LACC trial and the available data from other retrospective studies, we feel the MIS approach should not be simply abandoned. There may still be a role for MIS in cervical cancer surgery for properly and carefully selected cases and with detailed counseling; surgeons should analyze their own outcomes closely in order to perform such counseling. Modification of surgical technique and maintaining proper oncologic surgical principles are key for MIS to remain a viable option. Tumor manipulation and contamination should be avoided. Transcervical uterine manipulators should not be used. Cervical and tumor containment prior to colpotomy, as is performed during an open approach, is required. This will all require validation in future trials. We await the results of ongoing randomized trials to further inform us. A one-size-fits-all approach may be short-sighted; we may need to decide treatment strategy based on the notion of the right surgical approach for the right patient by the right surgeon.
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Affiliation(s)
- Benny Brandt
- Department of Gynecologic Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mario M Leitao
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. .,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Benabou K, Khadraoui W, Khader T, Hui P, Fernandez R, Azodi M, Menderes G. Port-Site Metastasis in Gynecological Malignancies. JSLS 2021; 25:JSLS.2020.00081. [PMID: 33879998 PMCID: PMC8035826 DOI: 10.4293/jsls.2020.00081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Minimally invasive oncologic surgery has become the standard of care in many gynecologic cancers. While laparoscopic surgery provides many benefits to patients, such as faster recovery, there are unique challenges associated with minimally invasive techniques. Port-site metastasis is a rare complication after laparoscopic oncologic surgery in management of gynecologic malignancies. Methods: We present the case of a 44-year-old female with isolated port-site recurrence following laparoscopic radical hysterectomy with node-negative, clinical stage IB1 cervical adenocarcinoma. In addition, we provide an updated review of the literature on management and oncologic outcomes of port-site metastasis. Conclusion: Port-site metastasis prevention necessitates a better understanding of underlying risk factors and pathophysiology in order to optimize outcomes. Future studies are needed on risk-reducing strategies and standardization of management for port-site metastasis.
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Affiliation(s)
- Kelly Benabou
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Wafa Khadraoui
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Tarek Khader
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Rodrigo Fernandez
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Gulden Menderes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Shen W, Huang Y, Zhou Y, Chang B, Zhang M. Intestinal metastasis after total laparoscopic radical trachelectomy for stage IB1 cervical cancer: A case report. Gynecol Oncol Rep 2019; 28:37-40. [PMID: 30828599 PMCID: PMC6383171 DOI: 10.1016/j.gore.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/24/2022] Open
Abstract
•Simultaneous sigmoid colon and rectum metastasis after LRT.•Caution should be exercised in expanding conventional indications in fertility preserving surgery.•Cervical tumor exposure to CO2 should be avoided during surgery.
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Affiliation(s)
- Wenbin Shen
- Department of Gynecologic Oncology, Fudan Univeristy Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Yan Huang
- Department of Gynecologic Oncology, Fudan Univeristy Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Yuqi Zhou
- Department of Gynecologic Oncology, Fudan Univeristy Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Bin Chang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Meiqin Zhang
- Department of Gynecologic Oncology, Fudan Univeristy Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
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Isolated port site recurrence of node-negative clinical stage IB1 cervical adenocarcinoma. Gynecol Oncol Rep 2017; 20:54-57. [PMID: 28331901 PMCID: PMC5348602 DOI: 10.1016/j.gore.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 01/02/2023] Open
Abstract
Introduction Port site metastasis after laparoscopic surgery for cervical cancer is a rare phenomenon. Methods We present a case report of isolated port site recurrence 4 years following laparoscopic surgery in a patient with node-negative, clinical stage IB1 cervical adenocarcinoma. Results A 44 year-old woman presented with a necrotic cervical lesion. A biopsy of the mass revealed invasive endocervical adenocarcinoma. She underwent a robotic-assisted radical hysterectomy, bilateral salpingectomy, and pelvic lymph node dissection with bilateral oophoropexy. All lymph nodes were placed in an Endocatch bag prior to removal via the 12 mm assistant port. There was no clinical evidence of metastatic disease and final pathology revealed negative surgical margins and lymph nodes. Four years later, she re-presented with a soft tissue mass in her abdominal wall underlying the site of the prior laparoscopic assistant port. This was confirmed by transcutaneous biopsy to be metastatic adenocarcinoma of endocervical origin. Further work-up revealed no other evidence of metastatic disease. The recurrence was excised and all margins were negative. Conclusion This is the first case report describing an isolated port site recurrence in a patient who underwent robotic-assisted laparoscopic surgery for early-stage cervical adenocarcinoma with negative margins and negative lymph nodes. The mechanism underlying this isolated recurrence remains unknown. Port-site metastasis is a rare complication after laparoscopic surgery. Port-site recurrence can occur in early stage, node-negative cervical cancer. Surveillance of port sites at post-operative follow-up visits is imperative. The mechanism underlying this isolated recurrence remains unknown.
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Port-site metastases in patients with gynecological cancer after robot-assisted operations. Arch Gynecol Obstet 2015; 292:263-9. [DOI: 10.1007/s00404-015-3658-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/09/2015] [Indexed: 12/29/2022]
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