Nodular fasciitis growing at the port site of robotic surgery for rectal cancer

Background Nodular fasciitis (NF) is a type of rare and rapidly growing tumor that affects the muscular fascial layers. Due to its locally aggressive nature and rapid growth, NF can be mistaken as a malignant process on either clinical or histological grounds. Case presentation A 61-year-old man was affected by rectal cancer. We performed a robotic, high-anterior resection with lymph node dissection. According to the 8th edition of Union for International Cancer Control, the diagnosis was stage I pT2N0M0. During a routine follow-up 1.5 years after the robotic surgery, a computed tomography examination revealed a tumor in the upper right abdominal wall, at the site of the surgical port, that measured 45 mm. Magnetic resonance imaging indicated a hypo-intensive mass within the right straight muscle of the abdomen. Port site recurrence following the robotic surgery for rectal cancer was suspected, and an ultrasound-guided fine-needle aspiration was performed; it revealed a low-grade myofibroblastic tumor or benign neoplasm, but was inconclusive. We performed an excision of the lesion, and histopathology confirmed NF, seen as a solid, nodular, spindle-cell lesion. The patient was postoperatively followed for more than 1 year without any sign of recurrence of either cancer or NF. Conclusions NF is histologically benign, but local recurrence frequently occurs. We encountered a patient with NF at the port site after robotic surgery for rectal cancer.

Cutaneous port-site recurrence secondary to tumour seeding following implantation of an intraperitoneal chemotherapy access port for gastric cancer

Intraperitoneal chemotherapy has shown promising results for the treatment of peritoneal carcinomatosis in gastric cancer. However, the implantation of an intraperitoneal chemotherapy port may be associated with catheter-related complications. The authors describe a case of cutaneous port-site recurrence secondary to tumour seeding from an intraperitoneal chemotherapy access port.

LAPAROSCOPIC COLORECTAL SURGERY;

Objective: The aim of this study was to assess the outcome of laparoscopiccolorectal procedures performed in a district general hospital within 5 years period and tocompare it with patients who had an open procedure during the same period. Patients andMethods: Data were collected retrospectively from patient’s case notes retrieved from hospitalmedical records. One hundred consecutive cases of laparoscopic colonic resection includingboth benign and malignant diseases between 2005 and 2010 were analysed for perioperativeand long term outcome and were compared with consecutive one hundred cases of opencolectomies. Results: Overall conversion rate was 6% for laparoscopic group. The mean majorcomplication rates in laparoscopic group were 5% (3% in open group) and minor complicationsoccurred in 18% (28% in open group). There was no mortality in either group. The overallmorbidity rate was 23% in laparoscopic group as compared to 31% in open colectomy group. In64 cases, curative laparoscopic resections were performed for colorectal malignancy while 72patients had resections for cancer in open group. The mean lymph node harvest in laparoscopicgroup was 13.2 nodes as compared to 12.4 in open group; no port-site recurrence wasdocumented at a mean follow-up of 26 months. Average duration of surgery was 180 minutes ascompared to 140 minutes in open group. Mean postoperative hospital stay was reduced from 13days to 7 days. (Open Vs. Lap). There was no statistically significant difference in majorcomplication rates and mortality. Conclusions: Laparoscopic colorectal surgery is safe andfeasible in elective colorectal cases and reduces the hospital stay without any added morbidity.

Images: Port site recurrence on followup imaging after adrenalectomy for adrenocortical carcinoma — first indicator of carcinomatosis

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy of the adrenal cortex. Complete surgical resection is essential for localized tumours because ACC is highly resistant to chemotherapy and radiotherapy.1 Use of a laparoscopic approach for adrenalectomy in the setting of a confirmed or suspected ACC is controversial because it is unknown if laparoscopy provides equivalent oncological outcomes compared to an open approach.