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Exfoliated cancer cells during intersphincteric resection for very low rectal cancer

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Abstract

Purpose

To investigate the frequency of exfoliated cancer cells and the efficacy of rectal washout during intersphincteric resection (ISR) in patients not receiving chemoradiotherapy (CRT) for very low rectal cancer.

Method

The subjects of this prospective study were 16 consecutive patients who underwent ISR without CRT for very low rectal cancer. Brushing cytology of the posterior anorectal wall was performed twice in each step of the ISR procedure and the samples were sent for blind cytological examination to identify exfoliated cancer cells.

Results

Exfoliated cancer cells were identified in 9 of 13 patients (69%) preoperatively. The number of cancer cells identified after abdominal total mesorectal dissection decreased significantly from 94% (15/16) to 25% (4/16) after transanal irrigation with 2000 mL saline (p < 0.001). No cancer cells were identified after swabbing the anal wall following transanal dissection with purse-string closure of the distal stump. No suture-line recurrence was found during a median follow-up duration of 6 years.

Conclusion

Exfoliated cancer cells, confirmed in 94% of patients after total mesorectal excision, could be eliminated by performing rectal irrigation after clamping the rectum proximal to the tumor and swabbing the anorectal wall during ISR.

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Authors and Affiliations

  1. Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan

    Yoshikazu Koide, Tsunekazu Hanai, Koji Masumori, Hiroshi Matsuoka, Yeong Cheol Cheong & Ichiro Uyama

  2. International Medical Center, Fujita Health University Hospital, 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Kotaro Maeda

  3. Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan

    Hidetoshi Katsuno & Tomoyoshi Endo

Authors
  1. Yoshikazu Koide
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  2. Kotaro Maeda
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  3. Hidetoshi Katsuno
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  4. Tsunekazu Hanai
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  5. Koji Masumori
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  6. Hiroshi Matsuoka
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  7. Tomoyoshi Endo
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  8. Yeong Cheol Cheong
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  9. Ichiro Uyama
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Corresponding author

Correspondence to Kotaro Maeda.

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Yoshikazu Koide and the co-authors have no conflicts of interest.

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Koide, Y., Maeda, K., Katsuno, H. et al. Exfoliated cancer cells during intersphincteric resection for very low rectal cancer. Surg Today 50, 1652–1656 (2020). https://doi.org/10.1007/s00595-020-02064-w

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  • DOI: https://doi.org/10.1007/s00595-020-02064-w

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