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Updates in Surgery

, Volume 63, Issue 2, pp 109–113 | Cite as

Lack of prognostic role of pre- and postoperative peritoneal cytology and cytokeratin PCR-expression on local recurrence after curative anterior resection for mid-low rectal cancer

  • Donato F. AltomareEmail author
  • Michele Tedeschi
  • Maria-Teresa Rotelli
  • Domenica Bocale
  • Domenico Piscitelli
  • Marcella Rinaldi
Original Article

Abstract

Local recurrence continues to be a major problem in rectal cancer. After cancer removal, detection of viable cancer cells could be useful to identify patients at risk for local recurrence. Thus, aim of the study was the detection of residual peritoneal cancer cells with a possible prognostic role for local recurrence. Twenty-nine patients were operated (R0) for low (extraperitoneal) rectal cancer, without neoadjuvant radiochemotherapy. Before and immediately after cancer removal, a peritoneal lavage was done to evaluate by RT-PCR the cytokeratin 20 mRNA on isolated cells and in order to detect cancer cells by the Thin-prep test. After a median follow-up of 39 months, 5 patients died (17%), one for non-cancer-related disease, two (7%) for local recurrence and peritoneal carcinosis, and two for distant metastases. Preoperative cytology with Thin-prep test was positive in 4 patients (14%), while postoperative peritoneal cytology was positive only in 1 patient, different from the previous. No patient developed local or distal recurrence and all were disease-free at the end of the follow-up. RT-PCR analysis was positive on the peritoneal lavage after cancer removal in 11 patients. One died for unrelated cause and no one developed local recurrences. Local recurrence occurred in only 1 of the 2 patients with positive RT-PCR analysis on the first lavage and negative on the second lavage. Our study demonstrates a not important prognostic role of Thin-prep test and RT-PCR of cytokeratin 20 mRNA on the detection of patients at risk for local recurrence after curative resection of rectal cancer.

Keywords

Peritoneal cancer cells Rectal cancer Cytokeratin 20 RT-PCR Cancer recurrence Thin-prep 

Notes

Acknowledgments

This study was supported in part by a grant of the University of Bari. The authors thank Dr. Nelly Pellegrino for the revision of the paper.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Wong RK, Tandan V, De Silva S, Figueredo A (2007) Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev Apr 18:CD002102Google Scholar
  2. 2.
    Leong AF (2003) Total mesorectal excision (TME)—twenty years on. Ann Acad Med Singapore 32:159–162. ReviewPubMedGoogle Scholar
  3. 3.
    Williams NS, Dixon MF, Johnston D (1983) Reappraisal of the 5 centimeter rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. Br J Surg 70:150–154PubMedCrossRefGoogle Scholar
  4. 4.
    Bernstein TE, Endreseth BH, Romundstad P, Wibe A, Norwegian Colorectal Cancer Group (2009) Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 96:1348–1357PubMedCrossRefGoogle Scholar
  5. 5.
    Jensen LH, Altaf R, Harling H, Jensen M, Laurberg S, Lindegaard JC, Muhic A, Vestermark L, Jakobsen A, Bülow S, Danish Colorectal Cancer Group (2010) Clinical outcome in 520 consecutive Danish rectal cancer patients treated with short course preoperative radiotherapy. Eur J Surg Oncol 36:237–243PubMedGoogle Scholar
  6. 6.
    Hase K, Ueno H, Kuranaga N, Utsunomiya K, Kanabe S, Mochizuki H (1998) Intraperitoneal exfoliated cancer cells in patients with colorectal cancer. Dis Colon Rectum 41:1134–1140PubMedCrossRefGoogle Scholar
  7. 7.
    Guller U, Zajac P, Schnider A, Bosch B, Vorburger S, Zuber M, Spagnoli GC, Oertli D, Maurer R, Metzger U, Harder F, Heberer M, Marti WR (2002) Disseminated single tumor cells as detected by real-time quantitative polymerase chain reaction represent a prognostic factor in patients undergoing surgery for colorectal cancer. Ann Surg 236:768–775PubMedCrossRefGoogle Scholar
  8. 8.
    Aoki S, Takagi Y, Hayakawa M, Yamaguchi K, Futamura M, Kunieda K, Saji S (2002) Detection of peritoneal micrometastases by reverse transcriptase-polymerase chain reaction targeting carcinoembryonic antigen and cytokeratin 20 in colon cancer patients. J Exp Clin Cancer Res 21:555–562PubMedGoogle Scholar
  9. 9.
    Yamamoto S, Akasu T, Fujita S, Moriya Y (2003) Long-term prognostic value of conventional peritoneal cytology after curative resection for colorectal carcinoma. Jpn J Clin Oncol 33:33–37PubMedCrossRefGoogle Scholar
  10. 10.
    Noura S, Ohue M, Seki Y, Yano M, Ishikawa O, Kameyama M (2009) Long-term prognostic value of conventional peritoneal lavage cytology in patients undergoing curative colorectal cancer resection. Dis Colon Rectum 52:1312–1320PubMedCrossRefGoogle Scholar
  11. 11.
    Kanellos I, Zacharakis E, Kanellos D, Pramateftakis MG, Betsis D (2006) Prognostic significance of CEA levels and positive cytology in peritoneal washings in patients with colorectal cancer. Colorectal Dis 8:436–440PubMedCrossRefGoogle Scholar
  12. 12.
    Kanellos I, Demetriades H, Zintzaras E, Mandrali A, Mantzoros I, Betsis D (2003) Incidence and prognostic value of positive peritoneal cytology in colorectal cancer. Dis Colon Rectum 46:535–539PubMedCrossRefGoogle Scholar
  13. 13.
    Gozalan U, Yasti AC, Yuksek YN, Reis E, Kama NA (2007) Peritoneal cytology in colorectal cancer: incidence and prognostic value. Am J Surg 193:672–675PubMedCrossRefGoogle Scholar
  14. 14.
    Fujii S, Shimada H, Yamagishi S, Ota M, Kunisaki C, Ike H, Ichikawa Y (2009) Evaluation of intraperitoneal lavage cytology before colorectal cancer resection. Int J Colorectal Dis 24:907–914PubMedCrossRefGoogle Scholar
  15. 15.
    Lee IK, Kim DH, Lee Gorden D, Lee YS, Sung NY, Park GS, Kim HJ, Kang WK, Park JK, Ahn CH, Kim JG, Jeon HM, Oh ST (2009) Prognostic value of CEA and CA 19-9 tumor markers combined with cytology from peritoneal fluid in colorectal cancer. Ann Surg Oncol 16:861–870PubMedCrossRefGoogle Scholar
  16. 16.
    Makino T, Fujiwara Y, Takiguchi S, Miyata H, Yamasaki M, Nakajima K, Nishida T, Mori M, Doki Y (2010) The utility of pre-operative peritoneal lavage examination in serosa-invading gastric cancer patients. Surgery 148:96–102PubMedCrossRefGoogle Scholar
  17. 17.
    Rekhraj S, Aziz O, Prabhudesai S, Zacharakis E, Mohr F, Athanasiou T, Darzi A, Ziprin P (2007) Can intra-operative intraperitoneal free cancer cell detection techniques identify patients at higher recurrence risk following curative colorectal cancer resection: a meta-analysis. Ann Surg Oncol 15:60–68PubMedCrossRefGoogle Scholar
  18. 18.
    Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268PubMedCrossRefGoogle Scholar
  19. 19.
    Altomare DF, Guanti G, Hoch J, Vician M, Krivokapic Z, Bergamaschi R, Colorectal Micrometastases Study Group (2010) Noncolonic cancer stem cells in bone marrow of colorectal cancer patients. Colorectal Dis 12:206–212PubMedCrossRefGoogle Scholar
  20. 20.
    Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMedGoogle Scholar
  21. 21.
    McCall JL, Cox MR, Wattchow DA (1995) Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorectal Dis 10:126–132PubMedCrossRefGoogle Scholar
  22. 22.
    den Dulk M, van de Velde CJ (2007) Considerations and restrictions for non-operative treatment of rectal cancer in selected patients. Lancet Oncol 8:570–571PubMedCrossRefGoogle Scholar
  23. 23.
    Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following ‘curative’ surgery for large bowel cancer. I. The overall picture. Br J Surg 71:12–16PubMedCrossRefGoogle Scholar
  24. 24.
    Papailiou J, Bramis KJ, Gazouli M, Theodoropoulos G (2011) Stem cells in colon cancer. A new era in cancer theory begins. Int J Colorectal Dis 26:1–11Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Donato F. Altomare
    • 1
    Email author
  • Michele Tedeschi
    • 1
  • Maria-Teresa Rotelli
    • 1
  • Domenica Bocale
    • 1
  • Domenico Piscitelli
    • 2
  • Marcella Rinaldi
    • 1
  1. 1.General Surgery and Liver Transplantation Unit, Department of Emergency and Organ TransplantationUniversity Aldo Moro of BariBariItaly
  2. 2.Department of Human PathologyUniversity Aldo Moro of BariBariItaly

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