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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

The frequency of exfoliated malignant cells at the distal colon anastomosis site after every 100-ml increment of irrigation. The frequency decreased with increasing irrigation-fluid volume (*p = 0.0024). In volumes ≥300 ml in the no-touch group and ≥400 ml in the control group, exfoliated malignant cells were no longer detectable
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Fig3: The frequency of exfoliated malignant cells at the distal colon anastomosis site after every 100-ml increment of irrigation. The frequency decreased with increasing irrigation-fluid volume (*p = 0.0024). In volumes ≥300 ml in the no-touch group and ≥400 ml in the control group, exfoliated malignant cells were no longer detectable

Mentions: Exfoliated malignant cells were not detected at the distal colon anastomosis site during right hemicolectomy with a total irrigation-fluid volume of 300 ml or more in the no-touch group and 400 ml or more in the control group (Fig. 3).Fig. 3


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)

The frequency of exfoliated malignant cells at the distal colon anastomosis site after every 100-ml increment of irrigation. The frequency decreased with increasing irrigation-fluid volume (*p = 0.0024). In volumes ≥300 ml in the no-touch group and ≥400 ml in the control group, exfoliated malignant cells were no longer detectable
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: The frequency of exfoliated malignant cells at the distal colon anastomosis site after every 100-ml increment of irrigation. The frequency decreased with increasing irrigation-fluid volume (*p = 0.0024). In volumes ≥300 ml in the no-touch group and ≥400 ml in the control group, exfoliated malignant cells were no longer detectable
Mentions: Exfoliated malignant cells were not detected at the distal colon anastomosis site during right hemicolectomy with a total irrigation-fluid volume of 300 ml or more in the no-touch group and 400 ml or more in the control group (Fig. 3).Fig. 3

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