Decreased incidence of isolated tumor cells in lymph nodes after laparoscopic resection for colorectal cancer

Abstract

BackgroundLaparoscopic surgery has potential for less tumor cell spread because of the no-touch technique. We assessed the effect of the surgical approach (open versus no-touch laparoscopic) on the presence of tumor cells in sentinel lymph nodes (SN) of patients with stage I and II colorectal cancer.MethodsA single-center consecutive prospective series of patients operated on for colorectal cancer was analyzed. After conventional hematoxylin and eosin (H&E) staining, 107 patients without lymphatic metastases were included; 59 patients had open surgery, and 48 patients underwent laparoscopic resection. Patients in the laparoscopic group underwent a no-touch medial to lateral approach, whereas the conventional lateral to medial approach was applied in open surgery. A SN procedure was performed in all patients. The SNs were immunohistochemically analyzed for presence of occult tumor cells (OTC). According to the American Joint Committee on Cancer (AJCC) these tumor cells were divided into micrometastases (0.2–2 mm) or isolated tumor cells (ITC, < 0.2 mm).ResultsIn ten patients micrometastases were found, equally distributed between the two groups. However, ITC were more often found after open surgery (18 versus 5 patients, p = 0.03). Presence of OTC was related to depth of tumor invasion and tumor diameter > 3.5 cm. Logistic regression analysis identified lymphovascular invasion as a predictor for micrometastases [odds ratio (OR) 18.4], whereas open resection was predictive for presence of ITC (OR 3.3).ConclusionsNo-touch medial to lateral laparoscopic surgery results in less isolated tumor cells in lymph nodes compared with open lateral to medial surgery in patients with stage I and II colorectal cancer.

Interactions of occult tumor spread and surgical technique on overall and disease-free survival in patients operated for stage I and II right-sided colon cancer

“…A previous prospective study has compared laparoscopy (medial to lateral) to open (lateral to medial) surgery for colorectal cancer after performing sentinel node biopsy in all patients. They reported significant differences in ITC, while no difference was found for MM (Zaag 2011 ). This study is characterized by a limited but comparable number of patients (62 laparotomies, 45 laparoscopies) to our study.…”

“…The impact of specimen mobilization technique on cancer cell migration (medial/lateral (ML) vs. lateral/medial (LM)) has been debated since 1967 (Turnbull et al 1968). When MM/ITC are concerned the literature contains few studies.…”

“…When MM/ITC are concerned the literature contains few studies. Among these a study that compared numbers of MM/ITC between patients operated with laparoscopy to those operated with laparotomy after all patients underwent a sentinel node procedure, demonstrated only significantly higher numbers of ITC in the laparotomy group (Zaag 2011 ).…”

Extent of intraluminal exfoliated malignant cells during surgery for colon cancer: Differences in cell abundance ratio between laparoscopic and open surgery

“…Several studies have reported occlusion of the colon around the cancer at the beginning of surgery, which may prevent the spread of exfoliated malignant cells (17,18). Recently, studies found that circulating tumor cells in portal and peripheral blood and sentinel lymph nodes were lower in LC than in OC (19,20). Because these results suggest that exfoliated malignant cells are released during the operation, the operation is an important factor contributing to the presence of exfoliated malignant cells.…”