The Effects of Different Surgical Approaches on the Perioperative Level of Circulating Tumor Cells in Patients with Non-Small Cell Lung Cancer

Abstract

Background To observe and compare the effects of video-assisted thoracoscopic surgery (VATS) and conventional thoracotomy on the levels of circulating tumor cells (CTCs) in patients with non-small cell lung carcinoma (NSCLC). Methods Seventy-nine patients with a diagnosis of NSCLC were enrolled in the study. Forty-three were treated with VATS and 36 were treated with conventional thoracotomy. Blood samples were collected 3 days prior to surgery (d-3), during surgery (d0), and 3 days after surgery (d3). After epithelial cell adhesion molecule (EpCAM)-labeled immunomagnetic cell enrichment, anti-CK-PE and anti-CD45-FITC fluorescent-labeled monoclonal antibodies were added to sort CTCs. Quantification of CTCs was performed using multiparameter flow cytometry. Results The number of CTCs on d0 was significantly higher than on d-3 (5.730 ± 4.266 vs. 4.142 ± 3.971, p = 0.033) in both groups. There was no significant difference in the change of CTCs from before surgery to during surgery in the VATS and conventional thoracotomy (open) groups (1.363 ± 2.924 vs. 1.500 ± 2.315, p = 0.329). However, the increase in number of CTCs from before surgery to after surgery was significantly lower in the VATS group than in the conventional thoracotomy (open) group (2.181 ± 2.962 vs. 9.666 ± 15.641, p = 0.015). Thirty of the 79 patients tested positive for CTCs before surgery (37.97%). All benign lung disease patients and volunteers tested negative for CTCs. Conclusion A smaller increase in CTCs was seen in patients treated with VATS lobectomy than in patients treated with conventional thoracotomy. This reduction in number of postoperative CTCs may improve long-term survival.

Intraoperative detection of circulating tumor cells in pulmonary venous blood during metastasectomy for colorectal lung metastases

“…The increased yield from the tumor outflow as well as the higher numbers found after resection of the tumor suggests a release of the cells directly from the tumor tissue which could also be amplified by the manipulation during resection. However there is some data suggesting a significance of manipulation for tumor cell dissemination, it remains unclear to what extent surgical techniques impact tumor cell shedding into the circulation and if they do, what the capabilities of the released cells concerning further metastasization are 21 .…”

Circulating Tumor Cell Detection by Liquid Biopsy during Early-Stage Endometrial Cancer Surgery: A Pilot Study

“…One of the explanations was that laparoscopic approaches might enhance tumor cell detachment and mobilization. However, other studies showed that laparoscopy does not increase CTC release compared with open surgery [ 33 , 34 , 35 , 36 ].…”

Advances in Intraoperative Flow Cytometry

“…Approximately two-thirds of the patients with lung cancer with a potentially curative tumor resection will present tumor recurrence and/or disseminated disease [ 62 ]. According to Huang et al, lung cancer cells may disseminate immediately after surgical resection [ 64 ]. Therefore, the 5-year survival rate has been dismal in the past two decades [ 65 , 66 ].…”