Port-site metastasis of an upper urinary tract urothelial carcinoma after laparoscopic nephroureterectomy: a case report

We report here a case of ureteral cancer in which port-site metastasis was suspected after a nephroureterectomy. The patient was a male in his fifties with a chief complaint of asymptomatic gross hematuria. A tumor was found in his left renal pelvis and ureter by a computed tomographic (CT) scan. The patient was diagnosed with a left upper urinary tract cancer with a clinical stage of T2N0M0. A left laparoscopic nephroureterectomy was performed through a retroperitoneal approach. Lymph node dissection was performed with an ultrasonic surgical knife. The pathological diagnosis was an urothelial carcinoma, grade 2 > 3, INFbeta, pT3, pV1, pN2. He received two courses of MVAC chemotherapy (methotrexate 50 mg, vinblastine 5 mg, adriamycin 50mg, cisplatin 120 mg) postoperatively. Since retroperitoneal lymph node metastasis was observed three months later on a CT scan, the MVAC chemotherapy was repeated for three courses. Nine months later, a tumor was found in the hypodermic beside the port-site, and a needle biopsy confirmed a metastatic urothelial carcinoma. He received two courses of GP chemotherapy (gemcitabine 4,250 mg, paclitaxel 225 mg). He died of multiple metastases five months later.