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

Kobayashi, Shinichiro; Inoue, Yusuke; Fujita, Fumihiko; Ito, Shinichiro; Yamaguchi, Izumi; Nakayama, Masahiko; Kanetaka, Kengo; Takatsuki, Mitsuhisa; Eguchi, Susumu

doi:10.1111/ases.12617

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…The second problem, the dispersal of cancer cells in the abdominal cavity, is discussed in terms of: (1) The presence of cancer cells in the anastomotic intestinal tract; and (2) the prognostic value of a positive cytological diagnosis. First, it has been previously reported that, in colon cancer, the presence of free cancer cells in the intestinal tract to be anastomosed is as high as 30%-50%[ 22 , 23 ]. It has also been reported that the positive rate is higher for open surgery than for laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis

Kayano,

Mamuro,

Kamei

et al. 2024

World J Gastrointest Surg

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BACKGROUND Although intracorporeal anastomosis (IA) for colon cancer requires longer operative time than extracorporeal anastomosis (EA), its short-term postoperative results, such as early recovery of bowel movement, have been reported to be equal or better. As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum, there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells. However, intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified. AIM To clarify the effects of bacterial and tumor cell contamination of the intra-abdominal cavity in IA. METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020, 75 underwent EA (EA group), and 52 underwent IA (IA group). After propensity score matching, the primary endpoint was 3-year disease-free survival rates, and secondary endpoints were 3-year overall survival rates, type of recurrence, surgical site infection (SSI) incidence, number of days on antibiotics, and postoperative biological responses. RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups (87.2% and 82.7%, respectively, P = 0.4473). The 3-year overall survival rates also did not significantly differ between the IA and EA groups (94.7% and 94.7%, respectively; P = 0.9891). There was no difference in the type of recurrence between the two groups. In addition, there were no significant differences in SSI incidence or the number of days on antibiotics; however, postoperative biological responses, such as the white blood cell count (10200 vs 8650/mm3, P = 0.0068), C-reactive protein (6.8 vs 4.5 mg/dL, P = 0.0011), and body temperature (37.7 vs 37.5 °C, P = 0.0079), were significantly higher in the IA group. CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

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Section: Discussionmentioning

confidence: 99%

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis

Kayano,

Mamuro,

Kamei

et al. 2024

World J Gastrointest Surg

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“…Previously, exfoliated malignant cells were revealed at the site of an anastomosis during colorectal surgery, and it was suggested that the anastomotic site should be located more than 100 mm from the primary tumor. 11 Second, it is considered that this method might carry higher risks of contamination and related surgical site infections. Surgeons have to take care to prevent the spillage of intraluminal contents into the peritoneal cavity as much as possible, for example, using bowel clamping.…”

Section: Discussionmentioning

confidence: 99%

“…For example, exfoliated malignant cells may spill during the operation and contribute to peritoneal dissemination or port site recurrence in addition to anastomotic recurrence. Previously, exfoliated malignant cells were revealed at the site of an anastomosis during colorectal surgery, and it was suggested that the anastomotic site should be located more than 100 mm from the primary tumor 11 . Second, it is considered that this method might carry higher risks of contamination and related surgical site infections.…”

Section: Discussionmentioning

confidence: 99%

An experience of total laparoscopic partial colectomy with intracorporeal triangulating anastomosis in an obese patient with descending colon cancer

Okita

Tsukuda

Yamamoto

et al. 2021

Asian J Endoscop Surgery

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A 68‐year‐old woman was transferred to the emergency room of Okayama City Hospital because of worsening epigastric pain. After the examination, she was diagnosed with descending colon cancer, and laparoscopic colectomy was planned. However, exteriorization of the bowels to produce anastomosis was difficult because the rich adipose tissue of the mesocolon hardly stretched, and the abdominal wall was thick as the patient was obese. Therefore, an intracorporeal triangulating end‐to‐end anastomosis was performed. The colon was divided at 10 cm either side from the tumor using an endoscopic linear stapler. After the resection of the stumps with staples, the posterior walls were tied with stay sutures and then stapled with an endoscopic linear stapler. The anterior wall was stapled twice in the same manner, and the intracorporeal anastomosis was completed. The patient's postoperative course was uneventful. This technique provided an alternative intracorporeal anastomotic technique as troubleshooting in laparoscopic colectomy.

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“…With the introduction of ICA in colorectal surgery, there were initially concerns regarding oncological outcomes. In particular, it was suggested that malignant cell dissemination may occur when opening the intestinal tract within the abdomen resulting in peritoneal recurrence through leaked contents as well as inadequate lymph node harvesting 5,6 . It has been subsequently determined that both ECA and ICA have similar rates of lymph nodes harvested and retrieved enough nodes to ensure a radical cure 6 .…”

Section: Introductionmentioning

confidence: 99%

“…In particular, it was suggested that malignant cell dissemination may occur when opening the intestinal tract within the abdomen resulting in peritoneal recurrence through leaked contents as well as inadequate lymph node harvesting. 5,6 It has been subsequently determined that both ECA and ICA have similar rates of lymph nodes harvested and retrieved enough nodes to ensure a radical cure. 6 Additionally, studies have determined that there is comparable 3-and 5-year overall survival and disease-free survival between ICA and ECA in right and left hemicolectomy, with similar rates of peritoneal seeding found on follow-up.…”

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confidence: 99%

Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

Patel,

Naseem

2024

Asian J Endoscop Surgery

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IntroductionMinimally invasive colonic anastomosis can be performed intracorporeally or extracorporeally with laparoscopic or robotic assistance. In colorectal surgery, choosing the optimal approach is still controversial. Mainly, the debate involves balancing the potential benefits of intracorporeal anastomosis (ICA) with increased technical difficultly with the more straightforward and widely accepted extracorporeal anastomosis (ECA). Both techniques require different skill sets, and this study aims to identify barriers that prevent adoption of ICA.MethodsA 31‐point questionnaire survey was distributed through the General Surgeons Australia (GSA) platform of active general surgeon in Australia. It was open for 2 months between July and August 2023. Statistical analysis was completed using descriptive analysis and logistic regression.ResultsForty‐three general surgeons completed the survey. ECA was the most performed and preferred surgical technique. It was identified that increased operative time is the biggest barrier to completing ICA followed by lack of training and no perceived benefit with ICA. Patient comorbidities did not result in choosing ICA over ECA; however, surgeons with less experience and volume in colorectal surgery were more likely complete ECA in operations with increased technical difficulty.ConclusionAlthough ECA is the go‐to technique for many Australian general surgeons, it is evident that they may be overlooking the benefits offered by ICA. Further training is required to improve operative times and confidence in the technique. Ongoing research, audits of existing techniques, and updated training will assist surgeons becoming acquainted with the latest evidence and to offer the best care to their patients.

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

Abstract: Exfoliated malignant cells were detected at anastomosis sites in patients with colon cancer. On the distal side, laparoscopic colectomy may prevent the development of exfoliated malignant cells.

Cited by 4 publications

References 24 publications

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis

An experience of total laparoscopic partial colectomy with intracorporeal triangulating anastomosis in an obese patient with descending colon cancer

Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

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