卵巣癌初回手術前に腹腔鏡下胆嚢摘出術施行し、術後にポートサイトやその周囲に卵巣癌転移が発生した一例

抄録

　The safety of laparoscopic surgery for early stage ovarian cancer remains uncertain, and laparotomy is recommended. We examined a case in which laparoscopic surgery was performed before the first laparotomy for ovarian cancer unexpectedly, and ovarian cancer metastasis occurred at the port site and the circumference.

　A 48-year-old woman with left ovarian cancer was scheduled to undergo surgery, but acute cholecystitis developed, and an emergency laparoscopic cholecystectomy was performed.

　On the fifteenth postoperative day, because of acute abdomen and suspected ovarian tumor rupture, total hysterectomy, bilateral salpingo-oophorectomy, and omental biopsy laparotomy were performed. The postoperative pathological diagnosis was endometrial carcinoma with clear cell carcinoma, FIGO stage IC 2 (pT1c2pNXpM0).

　On the fifty-sixth day after laparotomy, a 10 mm sized tumor was found under the skin at the port site. Computed tomography (CT) revealed a mass in the right upper quadrant of the abdomen, a mass in the porta hepatis, the S4/5 region of the liver, and enlarged lymph nodes in the left external iliac region. It was considered that the ovarian cancer rapidly revived, and debulking surgery was performed. Recurrence of ovarian carcinoma was confirmed by pathological results, including a port-site mass.

　It is not a typical dissemination of ovarian cancer, and laparoscopic surgery might have resulted in metastasis. It should be prudent for the adaptation of laparoscopic surgery, even if it is an operation for a benign disease in a case, in which ovarian cancer is suspected.