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Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters--case series.

Oldhafer KJ, Stavrou GA, Donati M, Kaudel P, Frühauf NR - World J Surg Oncol (2013)

Bottom Line: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.Effectiveness of CK+ cell depletion and safety of the procedure was shown.The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22293 Hamburg, Germany. k.oldhafer@asklepios.com

ABSTRACT

Background: During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.

Methods: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.

Results: All patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.

Conclusions: Effectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

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Polarized light microscopy. Microscopic analysis (20× magnification) of filter medium showing cytokeratin positive (CK+) cells.
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Figure 5: Polarized light microscopy. Microscopic analysis (20× magnification) of filter medium showing cytokeratin positive (CK+) cells.

Mentions: The postoperative course was uneventful. Histology revealed multiple liver metastasis of an adenocarcinoma and a lymph node metastasis within the falciform ligament. CK+ cells, suspected as malignant cells, were detected in blood samples taken during mobilization of the liver and within the filter medium fibers which were analyzed microscopically (Figure 5). Comparable cells were not detected in blood samples from the filter outflow. The patient was discharged on the 27th POD in a good general condition. The patient died 22 months after liver resection due to hepatic tumor recurrence.


Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters--case series.

Oldhafer KJ, Stavrou GA, Donati M, Kaudel P, Frühauf NR - World J Surg Oncol (2013)

Polarized light microscopy. Microscopic analysis (20× magnification) of filter medium showing cytokeratin positive (CK+) cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721985&req=5

Figure 5: Polarized light microscopy. Microscopic analysis (20× magnification) of filter medium showing cytokeratin positive (CK+) cells.
Mentions: The postoperative course was uneventful. Histology revealed multiple liver metastasis of an adenocarcinoma and a lymph node metastasis within the falciform ligament. CK+ cells, suspected as malignant cells, were detected in blood samples taken during mobilization of the liver and within the filter medium fibers which were analyzed microscopically (Figure 5). Comparable cells were not detected in blood samples from the filter outflow. The patient was discharged on the 27th POD in a good general condition. The patient died 22 months after liver resection due to hepatic tumor recurrence.

Bottom Line: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.Effectiveness of CK+ cell depletion and safety of the procedure was shown.The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22293 Hamburg, Germany. k.oldhafer@asklepios.com

ABSTRACT

Background: During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.

Methods: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.

Results: All patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.

Conclusions: Effectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

Show MeSH
Related in: MedlinePlus