Challenges in Managing Delayed Port-Site Metastasis of Gallbladder Adenocarcinoma: A Case Report and Literature Review

Port-site metastasis following laparoscopic cholecystectomy for gallbladder adenocarcinoma, though rare, represents a critical oncological issue. The development of such metastasis is concerning due to the potential for delayed diagnosis and its implications for patient prognosis. We present the case of a 42-year-old female who developed a cutaneous metastasis at the epigastric port site six years after undergoing laparoscopic cholecystectomy for gallbladder adenocarcinoma. The metastasis manifested as an ulcero-proliferative mass with squamous differentiation. A biopsy confirmed poorly differentiated carcinoma. Despite the significant surgical history, the patient did not return for cancer evaluation or adjuvant therapy post-surgery, leading to this late complication. The occurrence of port-site metastasis underscores the diagnostic challenges and the critical need for vigilant long-term follow-up in patients with gallbladder carcinoma. This case highlights the importance of considering primary cutaneous malignancies in differential diagnoses and discusses the surgical complexities involved in managing such metastasis. The proximity of the mass to the subcostal margin and the risk of infection precluded the use of mesh during the excision, complicating the surgical approach. This also increased the patient's risk of incisional hernia, which would require further surgical intervention. This case illustrates the importance of long-term follow-up after laparoscopic cholecystectomy for gallbladder adenocarcinoma. Surgical challenges, including the difficulty of adequate margin in the epigastric region, risk of recurrence at port sites, and the potential need for further interventions for incisional hernia, must be considered to optimize patient outcomes.