The problem of port-site metastases after laparoscopic cancer surgery.

The whole era of laparoscopic surgery for cancer began with the same optimistic view as for benign disease. However, port-site metastases were published as soon as in 1993. According to literature, it is difficult to estimate exactly the incidence of port-site metastases in laparoscopic colon cancer surgery. Moreover, there are few reports of wound recurrences after open surgery although the incidence is probably about 1%. There are some hypothetical explanations of metastases to the laparoscopic wound, which have not been solved. It can be a haematogenic spread to the wound. Another mechanism could be an aerosol of tumour cells and a third one adhesions of tumour cells to the surface of the instruments or ports. This editorial discusses some of the possible mechanisms of port-site recurrences. Also, most importantly, the justification for laparoscopic surgery for colon cancer is discussed. Only through randomized trials can this question be solved. Therefore, it is mandatory to include patients in a trial and colorectal cancer patients should not undergo laparoscopic surgery outside a clinical randomized trial.