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Intraluminal exfoliated cancer cells and effectiveness of bowel ligatures during sigmoidectomy for sigmoid colon cancer

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Abstract

Purposes

To establish the efficiency of bowel ligatures in colon cancer surgery, focusing on the extent to which exfoliated cancer cells are shed in the colonic lumen during sigmoidectomy.

Methods

Twenty consecutive patients who underwent sigmoidectomy for sigmoid colon cancer were prospectively randomized into two groups: the “ligatures group”, in which bowel ligatures were placed, 3, 5, 10 cm from the tumor proximally and distally before dissection; and the “no ligatures group”, in which the corresponding sites were ligated only immediately before taking the specimen out. Each colonic segment ligated was irrigated with saline and samples were sent for blind cytological examination.

Results

Cancer cells were found in the colonic segment where the tumor was located, in 18 of 20 samples. The frequency of free cancer cells decreased from 50 to 0 % (p < 0.04) in the distal 3–5 cm colonic segment and from 80 to 20 % (p < 0.03) in the proximal colonic segment after performing bowel ligatures. Free cancer cells were confirmed in 1 of 10 samples at both colonic segments 5–10 cm from the tumor, even after bowel ligatures.

Conclusions

Intraluminal exfoliated cancer cells could be eliminated by placing bowel ligatures during sigmoidectomy. Measures should be considered to eliminate exfoliated cancer cells during colectomy, even after placing bowel ligatures.

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References

  1. Turnbull RB, Kyle K, Watson ER, Spratt J. Cancer of the colon: Influence of the no-touch isolation technique on survival rates. Ann Surg. 1967;166:420–5.

    Article  PubMed  Google Scholar 

  2. Kuramoto M, Hasuo T, Ishihara K, Ikeshima S, Iwatsuki M, Shimada S. A case of anastomotic recurrence of sigmoid colon cancer after functional end-to-end anastomosis. J Jap Surg Assoc. 2005;66:1976–9.

    Article  Google Scholar 

  3. Shiino Y, Ozaki T, Komuro M, Yamada H, Shinohara K, Kitahata Y. Study of suture line recurrence after laparoscopic colorectal surgery. Saitamaigakkaishi. 2005;39:461–4.

    Google Scholar 

  4. Moriguchi Y, Uehara K, Fujita S, Yamamoto S, Akasu T, Moriya Y. Two cases of anastomotic recurrence of colon cancer following functional end-to-end anastomosis. Rinsyougeka. 2006;61:1283–6.

    Google Scholar 

  5. Wakayama K, Maeda Y, Shinohara T, Hamada T, Naito H. A case of stapled suture line recurrence of sigmoid colon cancer after functional end to end anastomosis. J Jap Surg Assoc. 2007;68:2024–7.

    Article  Google Scholar 

  6. Ishiguro Y, Miyakura Y, Yasuda K. Suture line recurrence after colon cancer surgery. Gastroenterol Endosco. 2007;49:2998–9.

    Google Scholar 

  7. Futami R, Shimanuki K, Sugiura A, Tsuchiya Y, Kaneko M, Okawa K, Mineta S, Sugiura Y, Akimaru K, Taiji T. Recurrence of colonic cancer twice at the site of stapled colorectal anastomosis. J Nippon Med Sch. 2007;74:251–6.

    Article  PubMed  Google Scholar 

  8. Slanetz CA. Effect of no touch isolation on survival and recurrence in curative resections for colorectal cancer. Ann Surg Oncol. 1998;5:390–8.

    Article  PubMed  Google Scholar 

  9. Umpleby HC, Fermor B, Symes MO, Williamson RCN. Viability of exfoliated colorectal carcinoma cells. Br J Surg. 1984;71:659–63.

    Article  CAS  PubMed  Google Scholar 

  10. Jap Soc for Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. Tokyo: Kanehara & Co Ltd.; 1997. p. 4–25.

    Google Scholar 

  11. Ryall C. Cancer infection and cancer recurrence. Lancet. 1907;2:1311–6.

    Article  Google Scholar 

  12. Gordon-Watson C. Origin and spread of cancer of the rectum in relation to surgical treatment. Lancet. 1938;1:239–45.

    Article  Google Scholar 

  13. Pattana-arun J, Wolff BG. Benefit of povidone-iodine solution in colorectal operations: science or legend. Dis Colon Rectum. 2008;51:966–71.

    Article  PubMed  Google Scholar 

  14. Skipper D, Cooper AJ, Marston JE, Taylor I. Exfoliated cells and in vitro growth in colorectal cancer. Br J Surg. 1987;74:1049–52.

    Article  CAS  PubMed  Google Scholar 

  15. Gertsch P, Baer HU, Kraft R, Maddern GJ, Altermatt HJ. Malignant cells are collected on circular staplers. Dis Colon Rectum. 1992;35:238–41.

    Article  CAS  PubMed  Google Scholar 

  16. Jenner DC, de Boer WB, Clarke G, Levitt MD. Rectal washout eliminates exfoliated malignant cells. Dis Colon Rectum. 1998;41:1432–4.

    Article  CAS  PubMed  Google Scholar 

  17. Fermor B, Umpleby HC, Lever JV, Symes MO, Williamson RCN. Proliferative and metastatic potential of exfoliated colorectal cancer cells. J Natl Cancer Inst. 1985;76:347–9.

    Google Scholar 

  18. Yoshida K, Sugino T, Bolodeoku J, Warren BF, Goodison S, Woodman A, Toge T, Takahara E, Tarin D. Detection of exfoliated carcinoma cells in colonic luminal washings by identification of deranged patterns of expression of the CD44 gene. J Clin Pathol. 1996;49:300–5.

    Article  CAS  PubMed  Google Scholar 

  19. Maeda K, Maruta M, Hanai T, Sato H, Horibe Y. Irrigation volume determines the efficacy of “rectal washout”. Dis Colon Rectum. 2004;47:1706–10.

    Article  PubMed  Google Scholar 

  20. Stule JP, Petrelli NJ, Herrera L, Mittelman A. Anastomotic recurrence of adenocarcinoma of the colon. Arch Surg. 1986;121:1077–80.

    Article  Google Scholar 

  21. Matsumoto M, Maruta M, Maeda K, Utsumi T, Tohyama K, Msumori K. Suture line recurrence following curative resection for carcinoma of the colon-report of two cases. J Jap Surg Assoc. 1999;60:1341–4.

    Article  Google Scholar 

  22. Tsunoda A, Kawamura M, Nakao K, Yoshizawa H, Kawaguchi T, Marumori K, Cho H, Yasuda H, Satoh T, Arai K. Recurrence at the suture line following resection for carcinoma of the colon. J Jap Coloproctol. 1993;46:215–8.

    Article  Google Scholar 

  23. McGrew EW, Laws JF, Cole WH. Free malignant cells in relation to recurrence of carcinoma of the colon. JAMA. 1954;154:1251–4.

    Article  CAS  Google Scholar 

  24. Symes MO, Fermor B, Umpleby HC, Tribe CR, Williamson RC. Cell exfoliated from colorectal cancer can proliferate in immune deprived mice. Br J Cancer. 1984;50:423–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Skipper D, Jeffrey MI, Cooper AJ, Alexander P, Taylor I. Enhanced growth of tumor cells in healing colonic anastomoses and laparotomy wounds. Int J Colorectal Dis. 1989;4:172–7.

    Article  CAS  PubMed  Google Scholar 

  26. Docherly JG, McGregor JR, Akyol AM, Gordon DM, Galloway DJ. Comparison of manually constructed and stapled anastomoses in colorectal surgery. Ann Surg. 1995;221:176–84.

    Article  Google Scholar 

  27. Nicholls RJ. Surgery for rectal carcinoma. In: Nicholls RJ, Dozois RR, editors. Surgery of the colon and rectum. New York: Churchill-Livingstone; 1997. p. 442–62.

    Google Scholar 

  28. Phillips RK, Hittinger R, Belesovsky L, Fry JS, Fielding LP. Local recurrence following ‘curative’ surgery for large bowel cancer: II. The rectum and rectosigmoid. Br J Surg. 1984;71:17–20.

    Article  CAS  PubMed  Google Scholar 

  29. Cho H. Suture-line implantation in colorectal cancer surgery and efficacy of povidone-iodine solution –an experimental study-. J Jap Gastroenterol Surg. 1997;30:1847–55.

    Article  Google Scholar 

  30. Kyzer S, Gordon PH. The stapled functional end-to-end anastomosis following colonic resection. Colorectal Dis. 1992;7:125–31.

    CAS  Google Scholar 

  31. Wolmark N, Gordon PH, Fisher B, Weiand S, Lerner H, Lawrence W, Shibata H. A comparison of stapled and hand sewn anastomoses in patients undergoing resection for Dukes’ B and C colorectal cancer; an analysis of disease free survival and survival from NSABP prospective clinical trials. Dis Colon Rectum. 1986;29:344–50.

    Article  CAS  PubMed  Google Scholar 

  32. Pihl E, Hughes ESR, McDermott FT, Price AB. Recurrence of carcinoma of the colon and rectum at the anastomotic suture line. Surg Gynecol Obstetric. 1981;153:495–6.

    CAS  Google Scholar 

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Conflict of interest

Kotaro Maeda and his coauthors have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Fujita Health University School of Medicine, 1-98 Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Kotaro Maeda, Tsunekazu Hanai, Harunobu Sato, Koji Masumori, Yoshikazu Koide, Hiroshi Matsuoka & Hidetoshi Katsuno

  2. Department of Pathology, Fujita Health University School of Medicine, Toyoake, Japan

    Makoto Kuroda

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  1. Kotaro Maeda
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  2. Tsunekazu Hanai
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  3. Harunobu Sato
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  5. Yoshikazu Koide
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  7. Hidetoshi Katsuno
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Correspondence to Kotaro Maeda.

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Maeda, K., Hanai, T., Sato, H. et al. Intraluminal exfoliated cancer cells and effectiveness of bowel ligatures during sigmoidectomy for sigmoid colon cancer. Surg Today 44, 297–301 (2014). https://doi.org/10.1007/s00595-013-0788-x

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  • DOI: https://doi.org/10.1007/s00595-013-0788-x

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