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International Journal of Colorectal Disease

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Open Access 01-07-2011 | Original Article

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

Authors: Junichi Hasegawa, Junichi Nishimura, Shunsuke Yamamoto, Youichirou Yoshida, Kazuhiro Iwase, Kiyoshi Kawano, Riichiro Nezu

Published in: International Journal of Colorectal Disease | Issue 7/2011

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.

Gertsch P, Baer HU, Kraft R, Maddern GJ, Altermatt HJ (1992) Malignant cells are collected on circular staplers. Dis Colon Rectum 35:238–241PubMedCrossRef

McGregor JR, Galloway DJ, McCulloch P, George WD (1989) Anastomotic suture materials and implantation metastasis: an experimental study. Br J Surg 76:331–334PubMedCrossRef

Tsunoda A, Shibusawa M, Kawamura M, Murakami M, Kusano M (1997) Recurrent colonic cancer developing at the site of a stapled stump: report of a case. Surg Today 27:457–459PubMedCrossRef

Umpleby HC, Fermor B, Symes MO, Williamson RC (1984) Viability of exfoliated colorectal carcinoma cells. Br J Surg 71:659–663PubMedCrossRef

Anderberg B, Enblad P, Sjödahl R, Wetterfors J (1984) Recurrent rectal carcinoma after anterior resection and rectal stapling. Br J Surg 71:98–100PubMedCrossRef

Hurst PA, Prout WG, Kelly JM, Bannister JJ, Walker RT (1982) Local recurrence after low anterior resection using the staple gun. Br J Surg 69:275–276PubMedCrossRef

Goligher JC, Dukes CE, Bussey HJ (1951) Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg 39:199–211PubMedCrossRef

Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, Kameoka S, Saito Y, Takahashi K, Hase K, Oya M, Maeda K, Hirai T, Kameyama M, Shirouzu K, Muto T (2007) Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery 141:67–75PubMedCrossRef

Steichen FM (1968) The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses. Surgery 64:948–953PubMed

10.

Kuramoto M, Hasuo T, Ishihara K, Ikeshima S, Iwatsuki M, Shimada S (2005) A case of anastomotic recurrence of sigmoid colon cancer after functional end-to-end anastomosis. Journal of Japan Surgical Association 66:1976–1979

11.

Wakayama K, Maeda Y, Shinohara T, Hamada T, Naito H (2007) A case of stapled suture line recurrence of sigmoid colon cancer after functional end to end anastomosis. Journal of Japan Surgical Association 68:2024–2027CrossRef

12.

Shirato H, Watanabe T, Mimura T, Hayama T, Yamada H, Haku K, Nozawa K, Matsuda K, Takada T (2007) Two cases of anastomotic recurrence after functional end-to-end anastomosis performed for colon cancer. Jpn J Gastroenterol Surg 40:1727–1732

13.

O’Dwyer PJ, Martin EW Jr (1989) Viable intraluminal tumour cells and local/regional tumour growth in experimental colon cancer. Ann R Coll Surg Engl 71:54–56PubMed

14.

McGrew EA, Laws JF, Cole WH (1954) Free malignant cells in relation to recurrence of carcinoma of the colon. J Am Med Assoc 154:1251–1254PubMed

15.

Southwick HW, Harridge WH, Cole WH (1962) Recurrence at the suture line following resection for carcinoma of the colon: incidence following preventive measures. Am J Surg 103:86–89CrossRef

16.

Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 166:420–427PubMedCrossRef

17.

Jenner DC, de Boer WB, Clarke G, Levitt MD (1998) Rectal washout eliminates exfoliated malignant cells. Dis Colon Rectum 41:1432–1434PubMedCrossRef

18.

Maeda K, Maruta M, Hanai T, Sato H, Horibe Y (2004) Irrigation volume determines the efficacy of “rectal washout”. Dis Colon Rectum 47:1706–1710PubMedCrossRef

19.

Sayfan J, Averbuch F, Koltun L, Benyamin N (2000) Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer. Dis Colon Rectum 43:1710–1712PubMedCrossRef

20.

Docherty JG, McGregor JR, Purdie CA, Galloway DJ, O’Dwyer PJ (1995) Efficacy of tumoricidal agents in vitro and in vivo. Br J Surg 82:1050–1052PubMedCrossRef

21.

Umpleby HC, Williamson RC (1984) The efficacy of agents employed to prevent anastomotic recurrence in colorectal carcinoma. Ann R Coll Surg Engl 66:192–194PubMed

22.

Basha G, Penninckx F, Mebis J, Filez L, Geboes K, Yap P (1999) Local and systemic effects of intraoperative whole-colon washout with 5 per cent povidone-iodine. Br J Surg 86:219–226PubMedCrossRef

Title: Exfoliated malignant cells at the anastomosis site in colon cancer surgery: the impact of surgical bowel occlusion and intraluminal cleaning
Authors: Junichi Hasegawa
Junichi Nishimura
Shunsuke Yamamoto
Youichirou Yoshida
Kazuhiro Iwase
Kiyoshi Kawano
Riichiro Nezu
Publication date: 01-07-2011
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 7/2011
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1148-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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