1
|
Lim JH, Lee WY, Yun SH, Kim HC, Cho YB, Huh JW, Park YA, Shin JK. Can neoadjuvant chemoradiotherapy affect exfoliated cancer cells in colorectal cancer? BMC Surg 2024; 24:321. [PMID: 39425147 PMCID: PMC11487969 DOI: 10.1186/s12893-024-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 09/30/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND To prevent local recurrence caused by exfoliated cancer cells caught in the suture line, intraoperative rectal washout during surgery can be performed to eliminate exfoliated cancer cells. However, the impact of neoadjuvant chemoradiotherapy on exfoliated cancer cells is not well known. This study aimed to identify positive rate of malignant cells in rectal washout fluids of neoadjuvant chemoradiotherapy patients and to determine if neoadjuvant chemoradiotherapy could affect exfoliated cancer cells. METHODS A total of 105 patients who underwent rectal washout intraoperatively for distal sigmoid colon and rectal cancer from April 2020 to September 2021 were analyzed. The primary outcome was positive rate of malignant cells in rectal washout fluids of patients who had received neoadjuvant chemoradiotherapy. RESULTS The positive rate of malignant cells in washout fluids of patients who had received neoadjuvant chemoradiotherapy was 0.0% and those who had not was 32.1%. The overall positive rate was 23.8%. In the positive group, tumor sizes were bigger (4.64 ± 1.68 cm vs. 3.64 ± 2.00 cm, p = 0.026) and more patients had a fungating tumor shown in preoperative colonoscopy (96.0% vs. 71.3%, p = 0.012). Although these factors did not show statistical significance in multivariable logistic regression analysis, fungating tumor showed a trend towards significance (OR: 7.28, 95% CI: 0.90-58.77, p = 0.063). CONCLUSIONS Our study suggests that neoadjuvant chemoradiotherapy could reduce exfoliated cancer cells, and rectal washout for the purpose of eliminating exfoliated cancer cells might be unnecessary in patients who have received neoadjuvant chemoradiotherapy.
Collapse
Affiliation(s)
- Ji Ha Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea.
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Jung Kyong Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| |
Collapse
|
2
|
Suzuki Y, Hasegawa H, Mori T, Teramura K, Tsukada Y, Sasaki T, Kojima M, Ito M. Cytological Analysis of the Surgical Field During Transanal Total Mesorectal Excision for Rectal Cancer: A Prospective Study. Dis Colon Rectum 2024; 67:1009-1017. [PMID: 38653493 DOI: 10.1097/dcr.0000000000003300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND An unexpectedly large number of patients experienced local recurrence with transanal total mesorectal excision in Norway. This appears to be associated with cancer cell spillage during surgery. OBJECTIVE To investigate the surgical field cytology during transanal total mesorectal excision. DESIGN This was a prospective cohort study. SETTINGS This study was conducted at a single center between June and December 2020. PATIENTS Forty patients with rectal cancer underwent transanal total mesorectal excision. After irrigation of the surgical field, the water specimens were cytologically evaluated at 6 representative steps. The first sample was used as an initial control. The second, third, fourth, fifth, and sixth samples were collected after the first pursestring suture, rectotomy, the second pursestring suture, specimen resection, and anastomosis, respectively. The clinicopathological features and intraoperative complications of the patients were reviewed. MAIN OUTCOME MEASURES The primary outcome was to evaluate the presence of cancer cells in washing cytological samples. RESULTS Of the 40 consecutive patients enrolled in this study, 18 patients underwent neoadjuvant chemoradiotherapy. Incomplete first pursestring suture and rectal perforation were observed in 4 (10.0%) and 3 (7.5%) cases, respectively. In the first sample, 31 patients (77.5%) had malignant cells. Malignant findings were detected in 2 patients (5.0%) from the second to fifth samples. None of the sixth sample exhibited any malignant findings. LIMITATIONS This single-center study had a small sample size. CONCLUSIONS Cancer cells were initially detected by cytology, but only a few were observed throughout the procedure; however, cancer cells were not detected in the final surgical field. Further follow-up and novel studies are required to obtain clinically significant findings using cytology during transanal total mesorectal excision. See Video Abstract . ANLISIS CITOLGICO DEL CAMPO QUIRRGICO DURANTE LA ESCISIN TOTAL DEL MESORRECTO TRANSANAL PARA EL CNCER DE RECTO UN ESTUDIO PROSPECTIVO ANTECEDENTES:Un número inesperadamente grande de pacientes experimentó recurrencia local con la escisión total del mesorrecto transanal en Noruega. Esto parece estar asociado con el derrame de células cancerosas durante la cirugía.OBJETIVO:Investigar la citología del campo quirúrgico durante la escisión total del mesorrecto transanal.DISEÑO:Este fue un estudio de cohorte prospectivo.ENTORNO CLINICO:Este estudio se realizó en un solo centro entre junio y diciembre de 2020.PACIENTES:Cuarenta pacientes con cáncer de recto se sometieron a escisión total del mesorrecto transanal. Después de la irrigación del campo quirúrgico, las muestras de agua se evaluaron citológicamente en seis pasos representativos. La primera muestra se utilizó como control inicial. La segunda, tercera, cuarta, quinta y sexta muestras se recolectaron después de la primera sutura en bolsa de tabaco, la rectotomía, la segunda sutura en bolsa de tabaco, la resección de la muestra y la anastomosis, respectivamente. Se revisaron las características clínico-patológicas y las complicaciones intraoperatorias de los pacientes.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue evaluar la presencia de células cancerosas en el lavado de muestras citológicas.RESULTADOS:De los 40 pacientes consecutivos inscritos en este estudio, 18 pacientes se sometieron a quimiorradioterapia neoadyuvante. Se observaron la primera sutura en bolsa de tabaco incompleta y perforación rectal en cuatro (10,0%) y tres (7,5%) casos, respectivamente. En la primera muestra, 31 (77,5%) pacientes tenían células malignas. Se detectaron hallazgos malignos en dos pacientes (5,0%) de la segunda a la quinta muestra. Ninguno de la sexta muestra demostraron hallazgos malignos.LIMITACIONES:Este estudio unicéntrico tuvo un tamaño de muestra pequeño.CONCLUSIONES:Inicialmente se detectaron células cancerosas mediante citología, pero solo se observaron unas pocas durante todo el procedimiento; sin embargo, no se detectaron células cancerosas en el campo quirúrgico final. Se requieren más seguimientos y estudios novedosos para obtener hallazgos clínicamente significativos mediante citología durante la escisión total del mesorrecto transanal. (Traducción- Dr. Francisco M. Abarca-Rendon ).
Collapse
Affiliation(s)
- Yushi Suzuki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takashi Mori
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Motohiro Kojima
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
3
|
Meng L, Zhuming C, Xu H, Wang C, Hu S, Kai Z. Impact of rectal washout in local recurrence: a meta-analysis and systemic review. Wideochir Inne Tech Maloinwazyjne 2024; 19:129-140. [PMID: 38973800 PMCID: PMC11223550 DOI: 10.5114/wiitm.2024.138732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/15/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Rectal washout is proposed for eliminating free cancer cells, yet evidence on its efficacy in preventing local recurrence after anterior resection is inconclusive. Material and methods Contrasting rectal washout (RW) and non-rectal washout (NRW) in rectal cancer, a prospective study of randomized control trials (RCT) and non-randomized control trials (NRCT) from January 2005 to July 2023 was conducted using PubMed, Cochrane Library, and MEDLINE databases. Meta-statistical analysis in RevMan 5.4 addressed heterogeneity. Results In analysis involving 19,855 patients (15127 RW, 4728 NRW) from eight studies, RW significantly reduced local recurrence (OR = 0.48), intraoperative RW (OR = 0.65), radical resection margins (OR = 1.89), and neoadjuvant therapy (OR = 0.99) (all p < 0.05). Subgroup RCT analysis reinforced these findings. Conclusions Rectal washout correlates with improved outcomes, while non-washout patients benefit more from neoadjuvant therapy. Notably, rectal washout without neoadjuvant remains efficacious.
Collapse
Affiliation(s)
- Linhai Meng
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Chen Zhuming
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Huaiwen Xu
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Chaohui Wang
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Shuangjiu Hu
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Zhe Kai
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| |
Collapse
|
4
|
Mattart L, Magotteaux P, Blétard N, Brescia L, Debergh N, De Meester C, Demolin G, Dister F, Focan C, Francart D, Godin S, Houbiers G, Jehaes C, Jehaes F, Namur G, Monami B, Verdin V, Weerts J, Witvrouw N, Markiewicz S. Patient management after primary rectal cancer diagnosis. Special focus on surgical treatment for non-metastatic disease. Acta Chir Belg 2024; 124:208-216. [PMID: 37964580 DOI: 10.1080/00015458.2023.2278238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
Background: Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression).Methods: We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer.Results: The treatment began within 33 days (range 0-264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1-46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04-0.63; p = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis.Conclusion: This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.
Collapse
Affiliation(s)
- L Mattart
- Medical and business information, CHC Groupe Santé, Liège, Belgium
| | - P Magotteaux
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - N Blétard
- Department of pathology, CHC Groupe Santé, Liège, Belgium
| | - L Brescia
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - N Debergh
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - C De Meester
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - G Demolin
- Department of oncoloy, CHC Groupe Santé, Liège, Belgium
- Department of gastroenterology, CHC Groupe Santé, Liège, Belgium
| | - F Dister
- Department of imagery, CHC Groupe Santé, Liège, Belgium
| | - C Focan
- Department of oncoloy, CHC Groupe Santé, Liège, Belgium
| | - D Francart
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - S Godin
- Department of radiotherapy, CHU Liege, Liège, Belgium
| | - G Houbiers
- Department of oncoloy, CHC Groupe Santé, Liège, Belgium
- Department of gastroenterology, CHC Groupe Santé, Liège, Belgium
| | - C Jehaes
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - F Jehaes
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - G Namur
- Department of nuclear medicine, CHC Groupe Santé, Liège, Belgium
| | - B Monami
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - V Verdin
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - J Weerts
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - N Witvrouw
- Department of nuclear medicine, CHC Groupe Santé, Liège, Belgium
| | - S Markiewicz
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| |
Collapse
|
5
|
Svensson Neufert R, Jörgren F, Buchwald P. Impact of rectal washout on recurrence and survival after anterior resection for rectal cancer. BJS Open 2022; 6:6862619. [PMID: 36458839 PMCID: PMC9716868 DOI: 10.1093/bjsopen/zrac150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Rectal washout (RW) is routinely performed during anterior resection (AR) for rectal cancer to reduce local recurrence (LR), although is sometimes not performed during minimally invasive surgery (MIS) procedures due to technical challenges and time consumption. The aim was to investigate the impact of RW on the oncological outcome after AR for rectal cancer in a registry cohort. METHODS Data on patients registered in the Swedish Colorectal Cancer Registry who had undergone elective radical (R0) AR for TNM stage I-III rectal cancer between 2007 and 2017 with a 3-year follow-up were analysed. Multivariable analyses were performed and the primary endpoint was LR at 3 and 5 years after AR. The occurrence of distant metastasis (DM) and overall recurrence (OAR), overall survival, and relative survival were also analysed as a secondary aim. A subgroup analysis was performed for the same outcomes in patients treated with MIS. RESULTS Out of 6186 patients (1923 with TNM stage I, 1907 with TNM stage II, and 2356 with TNM stage III), RW was performed in 5706 (92.2 per cent). The median age of the cohort was 67 years. RW did not impact the 3-year risk of LR. LR within 5 years occurred in 104 of 4583 patients (2.3 per cent) in the RW group compared with 16 of 408 patients (3.9 per cent) in the no RW group (P = 0.037). In multivariable analysis of the LR risk, the HR was 0.53 (95 per cent c.i. 0.31 to 0.90), favouring RW. There were no differences in rates of DM and OAR, overall survival, and relative survival. A subgroup analysis of the 1410 patients undergoing MIS did not demonstrate any differences between the groups, given, however, the low rate of LR. CONCLUSIONS RW in AR for rectal cancer does not impact the 3-year oncological outcome; however, after the 5-year follow-up a reduction in LR risk was observed after RW.
Collapse
Affiliation(s)
- Rebecca Svensson Neufert
- Correspondence to: Rebecca Svensson Neufert, Department of Internal Medicine, Helsingborg Hospital, Charlotte Yhlens gata 10, SE-251 87 Helsingborg, Sweden (e-mail: )
| | - Fredrik Jörgren
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Pamela Buchwald
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
6
|
Svensson Neufert R, Jörgren F, Buchwald P. Rectal washout during abdominoperineal resection for rectal cancer has no impact on the oncological outcome. Colorectal Dis 2022; 24:284-291. [PMID: 34726339 DOI: 10.1111/codi.15977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/14/2021] [Accepted: 10/22/2021] [Indexed: 02/08/2023]
Abstract
AIM Intraoperative rectal washout is performed to eliminate exfoliated intraluminal cancer cells and thereby decrease the risk of local recurrence. Rectal washout in abdominoperineal resection has not been studied. The aim of this study was to assess the oncological outcome after rectal washout in abdominoperineal resection for rectal cancer and to find evidence as to whether rectal washout should be performed or not. METHOD Data for all patients registered in the Swedish Colorectal Cancer Registry who underwent elective surgery with abdominoperineal resection for rectal cancer (TNM Stages I-III) between 2007 and 2013 were analysed using multivariable analysis. RESULTS No significant differences were shown between the rectal washout group and the no rectal washout group for local recurrence [10/265 (3.8%) vs. 87/2160 (4.0%), p = 0.84], distant metastasis [51/265 (19.2%) vs. 476/2160 (22.0%), p = 0.29] or overall recurrence [53/265 (20.0%) vs. 505/2160 (23.4%), p = 0.21]. In multivariable analysis, rectal washout did not significantly affect the oncological outcome in terms of local recurrence, distant metastasis, overall recurrence or 5-year overall or relative survival. CONCLUSION Our results do not support routine rectal washout during abdominoperineal resection in order to improve the oncological outcome.
Collapse
Affiliation(s)
- Rebecca Svensson Neufert
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Fredrik Jörgren
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Pamela Buchwald
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
7
|
Teurneau-Hermansson K, Svensson Neufert R, Buchwald P, Jörgren F. Rectal washout does not increase the complication risk after anterior resection for rectal cancer. World J Surg Oncol 2021; 19:82. [PMID: 33740992 PMCID: PMC7980676 DOI: 10.1186/s12957-021-02193-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background To reduce local recurrence risk, rectal washout (RW) is integrated in the total mesorectal excision (TME) technique when performing anterior resection (AR) for rectal cancer. Although RW is considered a safe practice, data on the complication risk are scarce. Our aim was to examine the association between RW and 30-day postoperative complications after AR for rectal cancer. Methods Patients from the Swedish Colorectal Cancer Registry who underwent AR between 2007 and 2013 were analysed using multivariable methods. Results A total of 4821 patients were included (4317 RW, 504 no RW). The RW group had lower rates of overall complications (1578/4317 (37%) vs. 208/504 (41%), p = 0.039), surgical complications (879/4317 (20%) vs. 140/504 (28%), p < 0.001) and 30-day mortality (50/4317 (1.2%) vs. 12/504 (2.4%), p = 0.020). In multivariable analysis, RW was a risk factor neither for overall complications (OR 0.73, 95% CI 0.60–0.90, p = 0.002) nor for surgical complications (OR 0.62, 95% CI 0.50–0.78, p < 0.001). Conclusions RW is a safe technique that does not increase the 30-day postoperative complication risk after AR with TME technique for rectal cancer.
Collapse
Affiliation(s)
| | | | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | - Fredrik Jörgren
- Department of Surgery, Helsingborg Hospital, Helsingborg, Lund University, Lund, Sweden
| |
Collapse
|
8
|
Shimizu H, Sudo M, Furuya S, Takiguchi K, Saito R, Maruyama S, Kawaguchi Y, Kawaida H, Kondo T, Ichikawa D. Is Intraluminal Washout Necessary for Patients with Sigmoid Colon Cancer to Eliminate Exfoliated Cancer Cells as in Patients with Rectal Cancer? A Pilot Study at a Single Institute. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:145-150. [PMID: 32743117 PMCID: PMC7390616 DOI: 10.23922/jarc.2020-030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Objectives: Rectal stump washout has been widely performed to prevent the implantation of exfoliated cancer cells (ECCs) in patients with rectal cancer. However, it remains unclear whether intraluminal washout before transection is required in patients with sigmoid colon cancer. Therefore, this pilot study was conducted to elucidate the necessity of intraluminal washout for sigmoid colon cancer patients in comparison with rectal cancer patients by cytological assessments. Methods: A total of 16 patients with sigmoid colon cancer and 24 patients with rectal cancer who underwent sigmoidectomy or anterior resection with anastomosis using double-stapling technique were enrolled. A transanal washout sample was collected before washout and after irrigation with 500 and 1,000 mL of saline. Cytological assessments were conducted according to the Papanicolaou classification, and class IV and V cells were defined as malignant. Results: Before washout, exfoliated cancer cells were found in 15 of 24 (62.5%) patients with rectal cancer and in 1 of 16 (6.2%) patients with sigmoid colon cancer (p < 0.001). Distal-free margin from the tumor was significantly shorter in patients with cancer cells (p = 0.002), and the length of the distal-free margin was significantly associated with the tumor location. After irrigation with 500 and 1,000 mL of saline, no cancer cell was found in all patients with sigmoid colon cancer, whereas ECCs were still found in five patients with rectal cancer (20.8%). Conclusions: Intraluminal washout with 1,000 mL may be sufficient for sigmoid colon cancer patients with longer distal-free margin. A large-scale, randomized controlled study is necessary to confirm these results.
Collapse
Affiliation(s)
- Hiroki Shimizu
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan.,Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Sudo
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Koichi Takiguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Ryo Saito
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Suguru Maruyama
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| |
Collapse
|