Drain or not drain? A surgical dilemma using suction drain for drain site metastasis in a patient with uterine sarcoma

Year 2024, Volume: 24 Issue: 1, 40 - 43, 30.04.2024

Sevda Baş Mehmet Narin Emin Kapı Şule Gül Aydın Elife Aşut Sevtap Seyfettinoğlu

https://doi.org/10.59215/trsgo.1234200

Abstract

Drain placement is a common practice after major surgeries to prevent collection accumulation in the operation field, follow up against the risk of bleeding or anastomotic leakage, and facilitate wound healing, especially in patients with large amounts of ascites such as ovarian cancer. Although port site recurrences have been described after laparoscopic surgery, metastasis to the previous drain site rarely occurs after laparotomy in gynecologic cancer patients. Cutaneous involvement originating from uterine sarcoma is particularly unusual. Albeit rare, malignant-cell seeding along an artificial percutaneous tract should be kept in mind when deciding to place a drain. We present a case of uterine undifferentiated sarcoma recurrence at the surgical drain site after one year later of primary tumour resection.

Keywords

Sarcoma, Endometrial, Stromal, Neoplasm Seeding

Dren olmalı mı yoksa olmamalı mı ? Uterin sarkomlu bir hastada dren yeri metastazı için aspirasyon dren kullanımıyla ilgili bir cerrahi ikilem

Abstract

Major cerrahi işlemler sonrasında özellikle yumurtalık kanseri gibi asit fazlalığı olan hastalarda ameliyat alanında sıvı toplanmasını önlemek, kanama veya anastomoz kaçağı riskine karşı takip etmek ve yara iyileşmesini kolaylaştırmak için dren yerleştirilmesi yaygın bir uygulamadır. Laparoskopik cerrahiden sonra giriş yeri nüksleri tanımlanmış olmasına rağmen, jinekolojik kanser hastalarında laparotomiden sonra önceki dren yerine metastaz nadiren görülür. Uterus sarkomundan kaynaklanan cilt tutulumu özellikle sıra dışıdır. Bir dren yerleştirmeye karar verirken, nadir de olsa, yapay bir perkütan yol boyunca tümör ekilebileceği akılda tutulmalıdır. Biz bu olgu sunumda primer tümör rezeksiyonundan bir yıl sonra cerrahi dren bölgesinde uterus andiferansiye sarkom nüksü olan bir olguyu sunuyoruz.

Keywords

Sarkom, Endometriyal, Stromal, Neoplazm

References

• Bai H, Yang J, Cao D, Huang H, Xiang Y, Wu M, et al. Ovary and uterus-sparing procedures for low-grade endometrial stromal sarcoma: a retrospective study of 153 cases. Gynecol Oncol. 2014 Mar;132(3):654-60.
• Franchi M, Trimbos JB, Zanaboni F, v d Velden J, Reed N, Coens C, et al. Randomized trial of drains versus no drains following radical hysterectomy and pelvic lymph node dissection: a European Organisation for Research and Treatment of Cancer-Gynaecological Cancer Group (EORTC-GCG) study in 234 patients. Eur J Cancer. 2007 May;43(8):1265-8.
• Srisomboon J, Phongnarisorn C, Suprasert P, Cheewakriangkrai C, Siriaree S, Charoenkwan K. A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer. J Obstet Gynaecol Res. 2002 Jun;28(3):149-53.
• Bogani G, Sarpietro G, Ferrandina G, Gallotta V, DI Donato V, Ditto A, et al. Enhanced recovery after surgery (ERAS) in gynecology oncology. Eur J Surg Oncol. 2021 May;47(5):952-959.
• Copas PR, Spann CO, Thoms WW, Horowitz IR. Squamous cell carcinoma of the cervix metastatic to a drain site. Gynecol Oncol. 1995 Jan;56(1):102-4.
• Behtash N, Ghaemmaghami F, Yarandi F, Ardalan FA, Khanafshar N. Cutaneous metastasis from carcinoma of the cervix at the drain site. Gynecol Oncol. 2002 Apr;85(1):209-11.
• St Peter SD, Nguyen CC, Mulligan DC, Moss AA. Subcutaneous metastasis at a surgical drain site after the resection of pancreatic cancer. Int J Gastrointest Cancer. 2003;33(2-3):111-5.
• Lynam S, Young L, Morozov V, Rao G, Roque DM. Risk, risk reduction and management of occult malignancy diagnosed after uterine morcellation: a commentary. Womens Health (Lond). 2015 Nov;11(6):929-44.
• Hofer SO, Molema G, Hermens RA, Wanebo HJ, Reichner JS, Hoekstra HJ. The effect of surgical wounding on tumour development. Eur J Surg Oncol. 1999 Jun;25(3):231-43.
• Gao Q, Guo L, Wang B. The Pathogenesis and Prevention of Port-Site Metastasis in Gynecologic Oncology. Cancer Manag Res. 2020 Oct 6;12:9655-9663.
• Dandapani M, Seagle BL, Chacho MS, Shahabi S. Delayed and clinically isolated port site carcinosarcoma recurrence as an early indicator of disseminated disease. Gynecol Oncol Rep. 2015 Sep 1;14:12-5.
• Agostini A, Robin F, Jais JP, Aggerbeck M, Vildé F, Blanc B, et al. Peritoneal closure reduces port-site metastases: results of an experiment in a rat ovarian cancer model. Surg Endosc. 2002 Feb;16(2):289-91.