Long-Term Survival Following Port-Site Metastasectomy in a Patient with Laparoscopic Gastrectomy for Gastric Cancer: A Case Report

Abstract

A 78-year-old man underwent laparoscopy-assisted total gastrectomy for gastric cancer (pT3N0M0). Multiple port sites were used, including a 10 mm port for a videoscope at the umbilical point and three other working ports. During the six-month follow-up evaluation, a 2 cm enhancing mass confined to the muscle layer was found 12 mm from the right lower quadrant port site, suggesting a metastatic or desmoid tumor. Follow-up computed tomography imaging two months later showed that the mass had increased in size to 3.5 cm. We confirmed that there was no intra-abdominal metastasis by diagnostic laparoscopy and then performed a wide resection of the recurrent mass. The histologic findings revealed poorly differentiated adenocarcinoma, suggesting a metastatic mass from the stomach cancer. The postoperative course was uneventful, and the patient completed adjuvant chemotherapy with TS-1 (tegafur, gimeracil, and oteracil potassium). There was no evidence of tumor recurrence during the 50-month follow-up period.

Keywords: Laparoscopy; Metastasectomy; Recurrence.

Fig. 1. (A) Gastrofiberscopy showing a large fungating mass at the fundus. (B) Computed tomography shows a 10 cm fungating mass without definite lymph node enlargement.

Fig. 2. Port placements for the laparoscopy-assisted total gastrectomy.

Fig. 3. (A) The follow-up computed tomography 6 months after surgery showed a 2 cm abdominal wall mass at the right lower quadrant port site. (B) The mass increased in size to nearly 3.5 cm during the 2-month observation period.

Fig. 4. (A) Diagnostic laparoscopy revealed no peritoneal metastasis or peritoneal invasion of the recurrent mass. (B) The metastasectomy specimen shows a 3.5×3.0 cm poorly defined white soft mass without invasion of the peritoneum.

Fig. 5. The histologic findings of the primary tumor (A) and abdominal wall tumor (B) were similar and suggested poorly differentiated adenocarcinoma in both samples (A, B: H&E, ×200).