Should it be done in all cases including T1 lesions, or only when radical surgery is indicated?
I think that the correct answer It's when only necessary when radical surgery is indicated.
Port-excision is done as part of re-exploration for post-operatively detected histologically proven GB malignancy for staging purpose only (to rule out port-site metastasis which is considered advanced disease and often associated with peritoneal carcinomatosis). Port-site excision has no curative role.
Blumgart HPB surgery beautifully elaborates the said point. It should be done in all cases but as said earlier with no curative intent.
Port site recurrence is a sign of aggressive disease. It denotes the tumor biology. Excision is advised if radical surgery is planned and there is history of spillage during initial procedure or bag was not used for extraction. Contrary to previous reports of high port site recurrence as compared to open surgery; new studies suggest recurrence at Port site alone is as good as open scar site recurrence. If there occurs a spillage then all the ports need to be excised.
Moreover it is difficult to excise the whole tract through which the port was placed as often it is oblique. So routine excision is not absolute.
Good discussion,our practice is any diseased Gallbladder is removed in an Endobag.All Gall bladders following a radical resection any way removed in an endobag.Only time when an incidental carcinoma was found in a normal looking GB if the preoperative MRI was not available then we may consider excision of the port along with Radical surgery as mentioned above for staging purposes.
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