| BackgroundSince the first laparoscopic colorectal surgery was carried out by Jacobs in the early 90s, because of its less invasive, faster recovery, less hospital stay,more aesthetic and so on, and along with the contrive of laparoscopic surgical instruments such as ultrasonic scalpel, Argon scalpel, Laparoscopic radical resection colorectal cancer has been widespread launched throughout the world in recent decades, and become one of the most perfect surgery style in laparoscopic surgery on gastrointestinal tumor. Nevertheless there is still a series of disputes after CO2 pneumoperitoneum laparoscopic surgery about whether to promote the malignant tumors growth, easy recurrence, the prognosis after surgery, long-term survival rate of patients and how to prevent it, especially the influence of CO2 pneumoperitoneum on malignant tumor has become a focus on whether or not CO2 pneumoperitoneum can speed up malignant tumor growth and implantation metastasis. At present, most studies concentrate on the mechanism about Port-Site Metastases (PSM) and CO2 pneumoperitoneum how to promote malignant tumor cells proliferation etc, but there is lack of reports on blood circulation micrometastasis of tumor cells and its relationship with clinical pathology of CO2 pneumoperitoneum.ObjectivesTo detect the positive expression of tumor cells (the expression of CK20mRNA) in peripheral circulation in patients which underwent laparoscopic radical resection colorectal cancer, in order to approach the effect on blood circulation micrometastases of tumor cells and its relationship with clinical pathology, also to investigate its clinical significance.MethodsDuring July 2008 and August 2009, we enrolled 50 inpatients with colorectal cancer in our hospital. All the patients were divided into two groups randomly,one group was performed by laparoscopic operation approach,the other group was performed by traditional open operation approach,3 milliliter peripheral blood in antecubital was taken from each two groups patients, the day before operation and the day after operation. We extracted total RNA from each mononuclearcell which abstracted from two groups blood sample,and to detect its CK20rnRNA by RT-PCR method, the numerical data was processed by statistics software. we analyzed the relationship among quantitative variance of tumor cells in peripheral blood before and after operation with two different operation approach, patients's age, differenation of tumor tissue, clinical staging of tumor tissue and to determine the expression level on CK20 in tissue samples of colorectal cancer by immunohistochemical.ResultsIn patients underwent laparoscopic and traditional open radical resection colorectal cancer,CK20mRNA positive rate was 30.77%(8/26)and29.17%(7/24) before operation; 38.46%(10/26) and37.50%(9/24) after operation. There was no difference before or after operation (P>0.05). Compared with the two groups, the positive rate of CK20 mRNA expression had no significant difference either before or after operation (P>0.05). According to TNM staging,the CK20mRNA expression level of phase III patients was significantly higher than the phase I and phase II ones (P<0.05).The positive rate of CK20 in CK20mRNA positive patients was 57.14%, which was significantly higher than 35.29% in CK20mRNA negative patients. In laparoscopic operation group the quantitative increase level of tumor cells in peripheral blood was not correlated with patients's age(P>0.05),and significantly correlated with differentiate degree and clinical pathology stage of patients's colorectal malignant tumor.Conclusion1. Laparoscopic radical resection of colorectal cancer is the same as traditional open operation, which doesn't increase the positive rate of CK20mRNA in patients's peripheral blood, and doesn't increase the risk of blood circulation micrometastasis of tumor cells.2. In laparoscopic radical resection of colorectal cancer, the increase positive rate of tumor cells in peripheral blood had no significant relationship with patients's age, but had remarkable relationship with the level of CK20mRNA in patients's peripheral blood, differentiate degree of tumor, TNM staging, and metastasis of lymph node.Key wordsLaparoscopy Colorectal cancer tumor cell micrometastasis RT-PCR CK20... |
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