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Exfoliated malignant cells at the anastomosis site in colon cancer surgery: the impact of surgical bowel occlusion and intraluminal cleaning.

Hasegawa J, Nishimura J, Yamamoto S, Yoshida Y, Iwase K, Kawano K, Nezu R - Int J Colorectal Dis (2011)

Bottom Line: In the control group, 2 (11.1%) and 10 (55.6%) of 18 patients had exfoliated malignant cells at the terminal ileum and distal colon anastomosis sites, respectively; however, only 1 (7.1%) of the 14 patients in the no-touch group had exfoliated malignant cells at both the sites.The frequency of exfoliated malignant cells at the distal colon anastomosis site was significantly lower in the no-touch group (p = 0.0024).No exfoliated malignant cells were found upon saline irrigation of 400 ml or more in either group.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone, Kita-ku, Sakai, Osaka, 591-8025, Japan. j-hasegawa@orh.go.jp

ABSTRACT

Purpose: Exfoliated malignant cells, present along staple lines of anastomosis, may be responsible for anastomotic recurrence of colon cancer. We aimed to assess the impact of surgical bowel occlusion around the tumor and intraluminal lavage on the presence of exfoliated malignant cells at anastomosis sites in patients with colon cancer.

Methods: In this prospective study, 32 patients with colon cancer, requiring right hemicolectomy between January 2007 and September 2008, were randomly assigned to a control group (no surgical bowel occlusion; 18 patients) and a "no-touch" group that underwent surgical bowel occlusion around the tumor before tumor manipulation (14 patients). The fluid used intraoperatively to irrigate the portion of the bowel clamped distal to the tumor was examined cytologically, and exfoliated cells of cytological classes IV and V were considered malignant.

Results: In the control group, 2 (11.1%) and 10 (55.6%) of 18 patients had exfoliated malignant cells at the terminal ileum and distal colon anastomosis sites, respectively; however, only 1 (7.1%) of the 14 patients in the no-touch group had exfoliated malignant cells at both the sites. The frequency of exfoliated malignant cells at the distal colon anastomosis site was significantly lower in the no-touch group (p = 0.0024). No exfoliated malignant cells were found upon saline irrigation of 400 ml or more in either group.

Conclusion: Measures, such as surgical bowel occlusion around the tumor and intraluminal lavage, can prevent or eliminate exfoliated malignant cells at anastomotic sites in patients with colon cancer.

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Related in: MedlinePlus

a Site of intraluminal lavage before anastomosis. In the patients who underwent right hemicolectomy followed by FEEA, cross-clamps were placed at distances of 15 cm apart in the terminal ileum and distal colon after standard mobilization. A Foley catheter was introduced through the holes incised for insertion of the linear stapler, and 50 ml of warm saline was used to irrigate the intraluminal space at the anastomosis sites. b Cluster formation of exfoliated cancer cells. After every 50 ml increment of irrigation, 20 ml of discharge was collected for cytological examination. Exfoliated cancer cells of classes IV and V were considered malignant
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Fig1: a Site of intraluminal lavage before anastomosis. In the patients who underwent right hemicolectomy followed by FEEA, cross-clamps were placed at distances of 15 cm apart in the terminal ileum and distal colon after standard mobilization. A Foley catheter was introduced through the holes incised for insertion of the linear stapler, and 50 ml of warm saline was used to irrigate the intraluminal space at the anastomosis sites. b Cluster formation of exfoliated cancer cells. After every 50 ml increment of irrigation, 20 ml of discharge was collected for cytological examination. Exfoliated cancer cells of classes IV and V were considered malignant

Mentions: To irrigate the intraluminal space at the anastomosis sites, cross-clamps were applied at distances of 15 cm apart at the terminal ileum and distal colon after ligation of the regional vessels and standard mobilization of the colon, and holes were incised between the cross-clamps to insert a linear stapler for FEEA. A Foley catheter was introduced through the holes, and warm saline in a 50-ml plastic syringe was used to irrigate the intraluminal space at the anastomosis sites (Fig. 1a). A total irrigation-fluid volume of 500 ml in the distal colon and 100 ml in the terminal ileum was used.Fig. 1


Exfoliated malignant cells at the anastomosis site in colon cancer surgery: the impact of surgical bowel occlusion and intraluminal cleaning.

Hasegawa J, Nishimura J, Yamamoto S, Yoshida Y, Iwase K, Kawano K, Nezu R - Int J Colorectal Dis (2011)

a Site of intraluminal lavage before anastomosis. In the patients who underwent right hemicolectomy followed by FEEA, cross-clamps were placed at distances of 15 cm apart in the terminal ileum and distal colon after standard mobilization. A Foley catheter was introduced through the holes incised for insertion of the linear stapler, and 50 ml of warm saline was used to irrigate the intraluminal space at the anastomosis sites. b Cluster formation of exfoliated cancer cells. After every 50 ml increment of irrigation, 20 ml of discharge was collected for cytological examination. Exfoliated cancer cells of classes IV and V were considered malignant
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3117263&req=5

Fig1: a Site of intraluminal lavage before anastomosis. In the patients who underwent right hemicolectomy followed by FEEA, cross-clamps were placed at distances of 15 cm apart in the terminal ileum and distal colon after standard mobilization. A Foley catheter was introduced through the holes incised for insertion of the linear stapler, and 50 ml of warm saline was used to irrigate the intraluminal space at the anastomosis sites. b Cluster formation of exfoliated cancer cells. After every 50 ml increment of irrigation, 20 ml of discharge was collected for cytological examination. Exfoliated cancer cells of classes IV and V were considered malignant
Mentions: To irrigate the intraluminal space at the anastomosis sites, cross-clamps were applied at distances of 15 cm apart at the terminal ileum and distal colon after ligation of the regional vessels and standard mobilization of the colon, and holes were incised between the cross-clamps to insert a linear stapler for FEEA. A Foley catheter was introduced through the holes, and warm saline in a 50-ml plastic syringe was used to irrigate the intraluminal space at the anastomosis sites (Fig. 1a). A total irrigation-fluid volume of 500 ml in the distal colon and 100 ml in the terminal ileum was used.Fig. 1

Bottom Line: In the control group, 2 (11.1%) and 10 (55.6%) of 18 patients had exfoliated malignant cells at the terminal ileum and distal colon anastomosis sites, respectively; however, only 1 (7.1%) of the 14 patients in the no-touch group had exfoliated malignant cells at both the sites.The frequency of exfoliated malignant cells at the distal colon anastomosis site was significantly lower in the no-touch group (p = 0.0024).No exfoliated malignant cells were found upon saline irrigation of 400 ml or more in either group.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone, Kita-ku, Sakai, Osaka, 591-8025, Japan. j-hasegawa@orh.go.jp

ABSTRACT

Purpose: Exfoliated malignant cells, present along staple lines of anastomosis, may be responsible for anastomotic recurrence of colon cancer. We aimed to assess the impact of surgical bowel occlusion around the tumor and intraluminal lavage on the presence of exfoliated malignant cells at anastomosis sites in patients with colon cancer.

Methods: In this prospective study, 32 patients with colon cancer, requiring right hemicolectomy between January 2007 and September 2008, were randomly assigned to a control group (no surgical bowel occlusion; 18 patients) and a "no-touch" group that underwent surgical bowel occlusion around the tumor before tumor manipulation (14 patients). The fluid used intraoperatively to irrigate the portion of the bowel clamped distal to the tumor was examined cytologically, and exfoliated cells of cytological classes IV and V were considered malignant.

Results: In the control group, 2 (11.1%) and 10 (55.6%) of 18 patients had exfoliated malignant cells at the terminal ileum and distal colon anastomosis sites, respectively; however, only 1 (7.1%) of the 14 patients in the no-touch group had exfoliated malignant cells at both the sites. The frequency of exfoliated malignant cells at the distal colon anastomosis site was significantly lower in the no-touch group (p = 0.0024). No exfoliated malignant cells were found upon saline irrigation of 400 ml or more in either group.

Conclusion: Measures, such as surgical bowel occlusion around the tumor and intraluminal lavage, can prevent or eliminate exfoliated malignant cells at anastomotic sites in patients with colon cancer.

Show MeSH
Related in: MedlinePlus