| Background and purpose:Peritoneal metastasis is a common way of recurrence and metastasis of gastric cancer after operation. In recent over ten years, laparoscopic surgery for early gastric cancer has been improved gradually in techniques and received the same short and long term results as open surgery. While laparoscopic techniques are popular and advanced devices as ultra-sound knife emerge increasingly, laparoscopic surgery for advanced gastric cancer has de-veloped faster, and its feasibility and near results have been confirmed. However, long-term therapeutic effects were still in the observation. At present, the main anxiety about laparo-scopic surgery for advanced gastric cancer is that it maybe strengthen peritoneal implanta-tion metastasis. Previous literatures have demonstrated that intercellular adhesion mole-cule-1(ICAM-1),integrinβ1 and CD44 play important roles in peritoneal implantation metastasis of gastric cancer. CO2 pneumoperitoneum is the distinct technique of laparo-scopy. The impacts of artificial pneumoperitoneum on tumor-associated molecules such as adhesion molecules were involved in the studies concerning the effects on the metastasis of gastrointestinal malignant tumor by laparoscopic technique. But, there were fairly great discrepancies among those studies because of difference of experimental models and re-search methods. Furthermore, animal experiments are hard to imitate the true progress of human body operation. Therefore, by viewing the changes of the expressions of those ad-hesion molecules in peritoneum and peritoneal washes during laparoscopically assisted radical gastrectomy (LARG), the purpose of our study is to approach the possible effects of LARG on the peritoneal metastasis, and provide theoretical support for its safety and gen-eral progress.Methods:50 patients with gastric cancer in our center were selected as objects. According to Japanese Gastric Cancer Treatment Guidelines( 13th edition), radical gastrectomy were performed for 28 cases by laparoscopic surgery (laparoscopic group) and 22 cases by open surgery(open group). Between the two groups, there was no significant difference of clini-cal datas such as age, gender, tumor location and TNM cancer stage. Peritoneum of right upper belly were collected at various operation time(the beginning,2hour,4hour). The ex-pressions of ICAM-1 and integrinβ1 in peritoneum at the three operation times were de-tected by Immunohistochemistry. Peritoneal washes were collected for two times at the be-ginning and end of operation. The concentrations of soluble ICAM-1 and CD44v6 (sI-CAM-1,sCD44v6)were all detected by enzyme linked immunosorbent assay (ELISA).Results:1. At the operating 2hour and 4hour, the expression of ICAM-1 in peritoneum between laparoscopic group and open group were increased slightly, and yet no significant differ-ence was observed as comparison of the beginning(P<0.05). There was no difference of the changes of the expression of ICAM-1 in peritoneum between two groups(P>0.05)2. At the operating 2hour,obvious difference was not found in the expression of in-tegrinβ1 in peritoneum when compared to the beginning. Yet, the expression of integrinβ1 in peritoneum at the operating 4hour was strengthened manifestly as comparison of the be-ginning(P<0.05). However, no remarkable difference was found in the changes of the expression of integrinβ1 in peritoneum between two groups(P>0.05)3. In laparoscopic group,the concentrations of sICAM-1 and sCD44v6 in preoperative peritoneal washes were 218±34 ng/ml,62.8±19.4ng/ml, respectively. While in open group, they were 225±37ng/ml and 71.3±16.5ng/ml, respectively. They were no obviously differ-ent in comparison between two groups.4. Before the operation, those patients with poorly differentiated gastric cancer in two groups showed higher sICAM-1 levels when compared to patients whose tumors are well and moderately differentiated(P<0.05),but sCD44v6 levels of those patients were not re-lated with the degree of differentiation. The concentrations of sICAM-1 and sCD44v6 in preoperative peritoneal washes were all positive correlation with TNM cancer stage.5. The concentrations of sICAM-1 and sCD44v6 of postoperative peritoneal washes in laparoscopic group were 255±47 ng/ml,87.7±15.6ng/ml, respectively. When in open group, they were 268±53ng/ml and 91.2±17.1ng/ml. They are all increased remarkably as com-parison of the preoperative. However, there was no significant difference of the changes of sICAM-1 and sCD44v6 between the two groups(P>0.05).Conclusions:1. With the operation prolonging, the expressions of ICAM-1 and integrinβ1 in peri-toneum of patients with gastric cancer were increased gradually. Compared with open sur-gery, LARG did not promote the expression of ICAM-1 and integrinβ1 in peritoneum.2. The concentrations of sICAM-1 and sCD44v6 in preoperative peritoneal washes were positive correlation with TNM cancer stage. The concentrations of two adhesion molecules in postoperative peritoneal washes were increased obviously as comparison of the preoperative. But, LARG did not strengthen the expression of the two adhesion mole-cules in peritoneal washes when compared to open surgery.3. In this study, LARG was not associated with a greater risk for facilitating peritoneal implantation metastasis of gastric cancer than open surgery, and is worthwhile to further development and deep research. |
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