Reduced Dissemination of Circulating Tumor Cells With No-Touch Isolation Surgical Technique in Patients With Pancreatic Cancer

Abstract

Circulating tumor cells (CTCs) disseminate from the primary tumor and travel through the bloodstream and lymphatic system. The detection of and/or increase in the number of CTCs during a patient’s clinical course may be a harbinger of forthcoming overt metastasis. We aimed to examine the impact of 2 different surgical techniques, standard (ST) pancreaticoduodenectomy (PD) and no-touch isolation (NT) PD, on tumor behavior and outcome in patients with pancreatic cancer by using CTCs as biomarkers. In this pilot study, patients were randomized to either ST-PD (n = 6) or NT-PD (n = 6). Intraoperatively, blood samples were taken from the portal vein for measurement of CTCs before and immediately after removal of the tumor. An increase in CTCs was seen in 5 of 6 patients (83%) with ST-PD but no patients with NT-PD (P = .003). In the ST-PD and NT-PD groups, median overall survival was 13.0 and 16.7 months, respectively (P = .33); there was no difference in disease-free survival (P = .42). The use of NT-PD significantly reduced the number of CTCs in the portal vein with no benefit in survival outcomes compared with ST-PD, although more extensive studies are required.

Outcome of International Federation of Gynecology and Obstetrics Stage IIB Cervical Cancer From 2003 to 2012

“…One explanation for why the OS is not different between the NACT + RH and CRT groups could be that the tumor size is larger in FIGO stage IIB cervical cancer when compared with early-stage tumors, and therefore, there is an increased opportunity for the stage IIB tumors to be disseminated during or after surgery. 26 When considering the long-term prognosis of cervical cancer, especially in young patients, there is a special emphasis on how to improve the quality of life of cancer survivors without increasing the risk of tumor recurrence., Treatment-related complications in cancer therapy are inevitable; radiotherapy and CCRT both result in menopausal symptoms, sexual dysfunction, and irreversible damage to the pelvic organs. The adverse effects associated with these treatments lead to a poorer quality of life for survivors.…”

Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival

“…. Seventeen studies were suitable for inclusion, giving a total of 1472 patients for the meta‐analysis, of which 771 underwent an artery‐first pancreatoduodenectomy and 701 a standard pancreatoduodenectomy ( Table ). The mean(s.d.)…”

“…The posterior and anterior approaches were the most commonly described artery‐first approaches. Others included the mesenteric (inferior infracolic), medial uncinate, left posterior and superior approaches.…”

Clinical Significance of Circulating Tumor Cells in Pancreatic Cancer

“…Similarly, Gall et al has employed a no-touch isolation technique for pancreaticoduodenectomy. Although this new technique significantly reduced CTCs postoperatively compared to the standard technique, no survival benefits were observed [38]. Bissolati et al has found that the incidence of liver metastasis was significantly lower in patients without detectable CTCs compared to patients with CTCs (8% vs. 53%, p=0.038) [39].…”