Malignant cells are collected on circular staplers

Gertsch, Philippe; Baer, H. U.; Kraft, Rainer; Maddern, Guy J.; Altermatt, Hans Jörg

doi:10.1007/bf02051014

Cited by 165 publications

(95 citation statements)

References 25 publications

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“…substantial evidence exists indicating the presence of viable cancer cells in the bowel lumen of patients with colorectal cancer at the time of operation (14-16), which can be detected on suture or staple lines of anastomosis (17). Anastomotic leakage, the most frequent infectious complication found in this study, may lead to extraluminal implantation, which has the effect of upstaging the disease and increasing the incidence of locoregional relapse (13).…”

Section: Discussionmentioning

confidence: 66%

Postoperative infections are associated with adverse outcome after resection with curative intent for colorectal cancer

Tsujimoto¹,

Ueno²,

Hashiguchi³

et al. 2010

Oncology Letters

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Abstract. this study focused on the impact of post-operative infection on patient outcome after resection with curative intent for colorectal cancer. Postoperative surgical and medical complications have been implicated as a negative predictor of long-term outcome in various malignancies. We studied a population of 1083 patients who underwent resection with curative intent for colorectal cancer. these patients were divided into 2 groups based on the occurrence (65 patients, 6%) or absence (1018 patients, 94%) of postoperative complications due to infection. We investigated the demographic and clinicopathological features of each patient with and without postoperative infectious complications, as well as the impact of postoperative infection on long-term survival. results showed that patients with postoperative infectious complications had diabetes mellitus more frequently and also had urgent surgery compared to those without infectious complications. In addition, patients with postoperative infectious complications had a significantly more unfavorable outcome compared with those without postoperative infection in cancer-specific, but not overall survival. Multivariate analysis demonstrated that age, rectal cancer and tumor stage correlated with overall survival, but not postoperative infectious complications. However, postoperative infections, as well as gender, were associated with the length of time until the patient succumbed from the recurrence of colorectal cancer after resection for curative intent. thus, postoperative infectious complications are predictors of adverse clinical outcome in patients with colorectal cancer. However, further immunological study is necessary to confirm the biological significance of these findings.

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Section: Discussionmentioning

confidence: 66%

Postoperative infections are associated with adverse outcome after resection with curative intent for colorectal cancer

Tsujimoto¹,

Ueno²,

Hashiguchi³

et al. 2010

Oncology Letters

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“…Cancer cells have also been found on the doughnuts of bowel following the use of the circular stapler. 25 Rectal washout with saline has been shown to reduce the number of cancer cells within the lumen and at the site of the anastomosis. 26,27 The best results, however, come from performing the rectal washout with a hypotonic solution such as water and/or antiseptic.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative peritoneal lavage – who does it and why?

Whiteside

Tytherleigh²,

Thrush³

et al. 2005

Ann R Coll Surg Engl

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INTRODUCTION Intra-operative peritoneal lavage (IOPL) is widely practised but its benefits are unclear. The frequency and pattern of its use amongst general surgeons is investigated.METHODS A postal questionnaire was sent to 153 general surgical consultants and registrars enquiring about their use of IOPL. The surgeon was asked the volume and type of lavage fluid used, under various circumstances.RESULTS 118 (77%) questionnaires were returned. 115 (97%) surgeons used IOPL. The majority of surgeons (61%) lavaged until the fluid was clear, 20% used more than 1 l and 17% used between 500-1000 ml. In the case of the dirty abdomen (i.e. gross pus or faecal peritonitis), 47% used saline as the lavage fluid, 38% aqueous betadine, 9% water and 3% antibiotic lavage. Similar results were found in the case of a contaminated abdomen (i.e. a breached hollow viscus). 34% of surgeons used IOPL during clean cases. 36% used water lavage during intra-abdominal cancer surgery; 21% lavaged with saline and 17% with betadine. More registrars (47%) than consultants (29%) lavaged with water during cancer surgery. Consultants, however, used more aqueous betadine.CONCLUSIONS The frequency of use and choice of lavage fluid varies widely. The successful management of the septic abdomen rests on at least 3 tenants -systemic antibiotics, control of the source of infection and aspiration of gross contaminants. There is little good evidence in the literature to support IOPL in the management of the septic abdomen. The use of IOPL during cancer surgery is supported by in vitro evidence. The current use of IOPL, as shown by this study, appears not to be evidence based.

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“…Previous clinical studies have revealed that multiple clusters of malignant cells can collect on a circular stapler used to produce an anastomosis when resecting for rectal cancer [11,13,14]. Gertsch et al [13] and Jenner et al [11] reported that cytology revealed malignant cells in centrifuged saline used for washing circular staplers in nine of ten and eight of ten cases of low anterior resection, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Gertsch et al [13] and Jenner et al [11] reported that cytology revealed malignant cells in centrifuged saline used for washing circular staplers in nine of ten and eight of ten cases of low anterior resection, respectively. Such malignant cells that collect on a stapler can be trapped or implanted in the suture line when constructing an anastomosis and hence cause subsequent suture-line recurrence [11,[13][14][15].…”

Section: Discussionmentioning

confidence: 99%