The value of radioimmunoguided surgery in first and second look laparotomy for colorectal cancer
Radioimmunoguided surgery (RIGS) using an anti-CEA (A5B7) monoclonal antibody has been assessed in 52 patients (43 primary excisions and nine second look procedures) undergoing surgery for colorectal carcinoma. The antibody localized in 97.8 percent of primary tumours and in 88.8 percent of the principal tumor in second look procedures. Additional information concerning the extent of primary tumor was obtained in 11 of 43 patients (25.5 percent) undergoing excision of primary carcinoma and five of nine patients (55 percent) in the second look series. Incorrect information was obtained about the extent of the primary tumour in six patients (11.3 percent), whereas no incorrect information was obtained during second look procedures. RIGS correctly predicted the subsequent Dukes' staging in 77 percent of first look cases (sensitivity 65 percent, specificity 90 percent), although accurate identification of individual nodes was impossible. The technique influenced the surgical procedure performed in 2 of 43 cases (4.6 percent) in primary surgery and in three of nine patients undergoing second look laparotomy (33 percent). RIGS in primary colorectal carcinoma may provide additional information concerning extent of locally advanced tumors in particular and the principle that the subsequent surgery may be influenced has been established. The technique appears to have a greater role in second look procedures where it may help determine the extent of recurrent tumour. Larger follow-up series are required to define how the additional information provided by this technique may best be exploited.
Key wordsRadioimmunoguided surgery Colorectal cancer
Unable to display preview. Download preview PDF.
- 1.Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;2:1479–82.Google Scholar
- 5.Hall C, Silverman SH, Moore J, Thompson H, Keighley MRB. Intraoperative pelvic cytology accurately predicts those at risk of developing local recurrence of colorectal cancer (abstr). Br J Surg 1987;74:1149.Google Scholar
- 8.Martin DT, Hinkle GH, Tuttle S,et al. Intraoperative radioimmunodetection of colorectal tumour with hand-held radiation detector. Am J Surg 1985;50:672–5.Google Scholar
- 9.O'Dwyer PJ, Sickle-Santarello B, Mojzisik M, Thurston MD, Martin EW. Intraoperative radioimmunodetection of gastrointestinal neoplasms (abstr). Br J Surg 1987;74:1145.Google Scholar
- 11.Blair SD, Theodorou NA, Begent RH,et al. Comparison of anti-foetal microvillus and anti-CEA antibodies in peroperative radioimmunolocalisation of colorectal cancer. Br J Cancer 1989;61:891–4.Google Scholar
- 13.Ledermann JA, Begent RH, Bagshawe KD,et al. Repeated antitumour antibody therapy in man with suppression of the host response with cyclosporin A. Br J Cancer 1987;58:654–7.Google Scholar
- 20.McDonald JS. New approaches to management of colorectal carcinoma. Hosp Pract 1987;22:185–90.Google Scholar