Port-site metastases after diagnostic laparoscopy in advanced ovarian cancer: a case report and a systematic review of the literature

Background: Diagnostic laparoscopy is widely used in advanced ovarian cancer to assess resectability and avoid futile laparotomies. However, concerns persist regarding the risk of port-site metastases (PSM), a complication that remains poorly characterized, particularly in terms of clinical impact and management. Methods: We report a case of late-onset giant port-site metastasis occurring after diagnostic laparoscopy in a patient with advanced high-grade serous ovarian cancer. In addition, we conducted a systematic review of the literature according to PRISMA guidelines, including studies reporting PSM after laparoscopy in advanced ovarian cancer. Data on incidence, risk factors, surgical techniques, oncologic outcomes, and management strategies were extracted and analyzed. Results: The reported case illustrates an uncommon but clinically challenging presentation of delayed, rapidly progressive PSM that ultimately precluded surgical management. The systematic review included five eligible studies and revealed a wide variability in PSM incidence, ranging from 1.18% to 46.7%, depending on detection method and study design. Advanced FIGO stage, large-volume ascites, extensive peritoneal disease, and institutional expertise emerged as the main risk factors. Importantly, PSM did not appear to independently affect overall survival, acting instead as a surrogate marker of aggressive disease biology. Routine port-site resection achieved effective local control but was associated with a significantly increased risk of wound-related morbidity, without a demonstrated survival benefit. Conclusions: PSM following diagnostic laparoscopy in advanced ovarian cancer are more frequent than clinically appreciated when histologically assessed but do not appear to adversely influence prognosis beyond underlying disease burden. Routine port-site excision should be carefully weighed against its associated morbidity. Diagnostic laparoscopy remains an oncologically safe and cost-effective tool when appropriately performed in specialized centers, and its benefits outweigh the risks when integrated into a standardized surgical pathway.