Dissemination of Free Cancer Cells from the Gastric Lumen and from Perigastric Lymphovascular Pedicles during Radical Gastric Cancer Surgery

Han, Tae Su; Kong, Seong Ho; Lee, Hyuk‐Joon; Ahn, Hye Young; Hur, Keun; Yu, Jieun; Kim, Woo Ho; Yang, Han‐Kwang

doi:10.1245/s10434-011-1620-8

Cited by 107 publications

(68 citation statements)

References 29 publications

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“…Additionally, cancer cells can be released directly from the gastric lumen, which suggests that other contributing factors may also play a role both in iatrogenic tumor diffusion induced by surgery and in metastasis in the peritoneal cavity [9].…”

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confidence: 99%

D2 lymphadenectomy can disseminate tumor cells into peritoneal cavity in patients with advanced gastric cancer

Yu¹,

Ren²,

Xue³

et al. 2012

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We sought to determine the dissemination of gastric cancer cells before and after radical D2 surgery and to determine the effectiveness of EIPL in preventing post-operative peritoneal metastasis. 64 patients were recruited with advanced gastric cancer for our final analysis. Complete curative gastrectomy with D2 lymphadenectomy was performed on the 64 patients. Before surgery, peritoneal lavage fluid was collected for cytological analysis by cell smearing and immunohistochemistry to detect disseminated cancer cells (S1). Following tumor and lymph node resection, peritoneal lavage fluid was collected for cytological examination (S2). The patients were treated by extensive intra-operative peritoneal lavage (EIPL) with normal saline (n = 31) or distilled water (n = 33). The peritoneal lavage fluid was collected for cytological examination (S3). At S1 stage, 18 patients (28.1%) were positive for disseminated cancer cells in their abdominal fluid. After D2 lymphadenectomy, 34 patients (53.1%) had disseminated cancer cells in their abdominal fluid at stage S2, which indicated that the D2 lymphadenectomy caused in an additional 16 (16/46, 34.8%) patients positive for disseminated cancer cells. After EIPL with either normal saline or distilled water at the S3 stage), all the patients were negative for disseminated cancer cells in their abdominal fluid. A total of six patients died, and four patients had recurrencent cancer. These findings indicate that D2 lymphadenectomy can disseminate gastric cancer cells, and post-operative lavage of the abdominal cavity can eliminate cancer cell dissemination and decrease the risk of peritoneal metastasis.

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confidence: 99%

D2 lymphadenectomy can disseminate tumor cells into peritoneal cavity in patients with advanced gastric cancer

Yu¹,

Ren²,

Xue³

et al. 2012

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“…Their findings suggest that the use of distilled water is associated with significantly increased rates of tumor lysis in mice models of colorectal cancer cell intraperitoneal spillage. Moreover, the results of a recent innovative study by Han and colleagues suggested that inappropriate surgical technique during radical gastrectomy and lymph node dissection may be the causative factor in spilling malignant cells into the peritoneal cavity via the gastric lumen or poorly sealed lymphovascular pedicles [42]. Following this, the only ongoing randomized phase III trial to evaluate the prognostic value of EIPL in addition to standard treatment in gastric cancer is the Japanese CCOG 1102 study by Misawa et al [43], whereby this multi-institutional study aims to recruit 300 patients with resectable gastric cancer (including cytology positiveonly disease).…”

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confidence: 99%

A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

et al. 2014

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Gastric cancer patients with positive peritoneal cytology as the only marker of metastatic disease have poor prognoses. There is no universal consensus on the most appropriate treatment regimen for this particular patient group. We reviewed and analyzed published data to determine the optimal treatment regimen for patients with peritoneal cytology-positive gastric adenocarcinomas. Six electronic databases were explored [PubMed, Cochrane (Systematic Reviews and Controlled Trials), PROSPERO, DARE, and EMBASE]. The primary outcome was overall survival with secondary outcomes including patterns of recurrence and treatment-related morbidity. Six studies were included for data extraction. There was no significant heterogeneity between studies. The use of S1 monotherapy was associated with a significant survival benefit (HR 0.48; 95 % CI 0.32-0.70; p = 0.0002). Intraoperative intraperitoneal chemotherapy (IIPC) with adjuvant chemotherapy showed a trend toward improvement in overall survival (HR 0.70; 95 % CI 0.47-1.04; p = 0.08). A recent randomized controlled trial examining extensive intraperitoneal lavage (EIPL) with IIPC showed a significant improvement in overall survival (5-year overall survival, 43.8 % for EIPL-IPC group compared with 4.6 % for IPC group). However, these promising results need to be validated in larger prospective randomized trials.

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“…Specifically, Yang et al (15), by conducting ex vivo experiments on surgical specimens, demonstrated that if lymphovascular channels are not properly sealed, free cancer cells are spilled out. Therefore, during lymphadenectomy for gastric cancer, dissection with scissors or scalpel which may cause the opening of vessels, should be avoided, moreover all the visible lymphovascular vessels should be carefully closed with the use of clips or though energy-based devices (15).…”

Section: Additional Notesmentioning

confidence: 99%

Lymphadenectomy: how to do it?

Giacopuzzi¹,

Bencivenga²,

Cipollari³

et al. 2017

Transl. Gastroenterol. Hepatol.

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According to the more recent European guidelines, the D2 lymphadenectomy is considered the standard for curative intent treatment of patients with gastric cancer. Although, the surgical definition of D2 dissection and its technical aspects had been learned from Eastern surgeons in the past decades, some variations in the approach to D2 lymphadenectomy by European surgeons were detectable in randomized clinical trials dealing with lymphadenectomy. Despite in more recent years an improvement in surgical quality has been reported in European series, some differences in the practice of D2 dissection are thought to persist. As, these may contribute to discrepancies in gastric cancer survival observed across European countries, the standardization of surgical quality is an urgent need to improve the outcome of gastric cancer patients in Europe. In this manuscript, we focus on the technical aspects of the D2 dissection both in open and laparoscopic gastrectomy in order to contribute to the improvement of surgical care of gastric cancer in the West. cardial region. At this point, we perform a complete detachment of the greater omentum from the transverse mesocolon along the avascular plane. This dissection is continued toward the right and left with mobilization of hepatic and splenic colic flexures. On the left side, during colo-epiploic detachment, we find the left gastroepiploic artery and vein; these are cut at their origin from the splenic vessels allowing the removal of station No. 4sb.For tumors of the posterior gastric wall penetrating the serosa a bursectomy with complete removal of the inner peritoneal surface of the bursa omentalis is performed.Then, after opening the lesser omentum, we place a tape around the gastric body, in this way the stomach is pulledup so that by tractioning caudally the transverse colon, we have a good exposure of the origin of right gastroepiploic vessels.Hence, we first proceed to isolation and section of the right gastroepiploic vein proximally to its confluence with the middle colic vein, then we perform the section of the right gastroepiploic artery at its origin very close to pancreas border; at this time lymphadenectomy of nodes at station No. 6 (infrapyloric nodes) is performed removing the adipose tissue located between the trunk of Henle and the antero-superior pancreaticoduodenal vein together with dissection of corresponding portion of front face of pancreatic serosa. Of note, in this way infrapyloric nodes (station No. 6) and lymph nodes along the right gastroepiploic artery (station No. 4d) are dissected en bloc.At this point, we proceed with the dissection of right gastric vessels that is performed at their origin thus removal of suprapyloric nodes (station No. 5) is completed. The pylorus and the duodenal bulb are now mobilized so that we can transect the duodenum with a mechanical linear stapler placed 2-3 cm below the pylorus. Then a complete division of lesser omentum is done.In case of total gastrectomy, gastric mobilization continues with resection of th...

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Dissemination of Free Cancer Cells from the Gastric Lumen and from Perigastric Lymphovascular Pedicles during Radical Gastric Cancer Surgery

Abstract: Free cancer cells can be released from gastric lumen or lymphovascular pedicles opened during gastric cancer surgery, especially in advanced-stage disease. Care should be taken to minimize spillage from the gastric lumen and lymphovascular pedicles.

Cited by 107 publications

References 29 publications

D2 lymphadenectomy can disseminate tumor cells into peritoneal cavity in patients with advanced gastric cancer

D2 lymphadenectomy can disseminate tumor cells into peritoneal cavity in patients with advanced gastric cancer

A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

Lymphadenectomy: how to do it?

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