23%.23 Given Tipifarnib cancer that many patients undergoing laparoscopic surgery are discharged early from the hospital, early evaluation during the postoperative period (1�C2 weeks) is warranted. Patients should also be instructed to report issues with nausea, vomiting, and/or protrusion at trocar sites. An incisional hernia may be repaired laparoscopically if the involved site is known. However, if the involved site is not obvious, laparotomy is often indicated to repair the defect. Port-Site Metastases In 1978, D?br?nte and colleagues documented the first case of port-site metastasis in a patient with ovarian carcinoma.24 Since then, a number of similar cases involving patients with gynecologic malignancies have been recorded in the literature.

In addition, port-site metastasis complicating cancer of the pancreas,25 esophagus,26 stomach,27 liver,28 and colon29 has also been reported. The incidence of port-site metastasis is relatively rare and poorly defined. Childers and colleagues reported on 105 laparoscopic procedures involving patients with documented malignancies and observed a port-site metastasis rate of 1.1% per procedure or 0.3% per puncture site.30 When compared with the rate of wound-site metastasis in patients undergoing laparotomy or percutaneous needle aspiration for malignant disease, the rate is similar. Several etiologic factors have been proposed for the occurrence of port-site metastasis and include direct wound contamination with viable tumor cells, effects of pneumoperitoneum, effects of specific gases, the ��chimney effect,�� and surgical techniques.

The chimney effect refers to the high efflux of gas from the abdominal cavity through the space around the trocars and, upon deflation of the abdomen, through the trocar incision site. This concept remains controversial in that although some investigators have been able to isolate tumor cells escaping from the port sites, other groups were not able to show aerosolization of viable tumor cells in either in vivo or in vitro experiments.31�C33 Several efforts have been suggested in an attempt to prevent port-site metastasis. Port-site lavage with cytotoxic agents has been recommended by some authors. Solutions such as heparin, taurolidine, combination heparin and taurolidine,34 5-fluorouracil,35 doxorubicin,36 povidine-iodine solution, and methotrexate have been implimented.

37 The utility of laparoscopic surgery in the setting of advanced ovarian cancer remains a topic of debate. However, the majority of patients diagnosed with an ovarian malignancy and subsequently found to develop a port-site metastasis are diagnosed with advanced disease. A large percentage AV-951 of these patients have evidence of ascites and carcinomatosis at the time of surgery. Kindermann and colleagues proposed that the laparoscopic management of ovarian malignancies and borderline tumors be abandoned based on a high rate of port-site metastases.