Tumor seeding in urological laparoscopy: An international survey

Purpose: During the last 10 years laparoscopy has been applied to treat most urologicalpathology including malignancies. There has been concern regarding peritoneal disseminationand port site metastases. We undertook a survey to assess the incidence of this occurrence.Materials and Methods: A total of 50 international urology departments with experts inlaparoscopic urological surgery were contacted for this study. Each site was asked to complete a2-page survey regarding the volume of laparoscopic urological procedures and port site recurrences.Results: Nineteen sites elected to participate. A total of 18,750 laparoscopic procedures wereperformed, of which 10,912 were for cancer. These included 2,604 radical nephrectomies, 559nephroureterectomies, 555 partial nephrectomies, 27 segmental ureterectomies, 3,665 radicalprostatectomies, 1,869 pelvic lymph node dissections, 479 retroperitoneal lymph node dissections,336 adrenalectomies and 108 procedures listed as other. Tumor seeding was reported in 13cases (0.1%), including 3 nephroureterectomies for transitional cell carcinoma, 4 nephrectomies(incidental transitional cell carcinoma), 4 adrenalectomies for metastases, 1 retroperitoneallymph node dissection for testicular cancer and 1 pelvic lymph node dissection for cancer of thepenis. Port seeding occurred in 10 cases (0.09%) and peritoneal spread in 3 cases (0.03%).Conclusions: The incidence of tumor seeding after laparoscopic oncological surgery is rare anddoes not appear greater than what has been historically reported for open surgery. Tumorseeding seems to be most commonly related to the removal of high grade tumors and deviationfrom oncological surgical principles.