Effect Of Laparoscopic Colorectal Cancer Radical Resection On Tumor Cell Exfoliation And Seeding

0bjectiveTo evaluate the influence of the laparoscopic coloreactal cancer radical resection on exfoliated of cancer cells.Methods1,This study was designed as a prospective, randomized clinical trial with a total of 80 patients from June 2009 to April 2010,40 patients were randomized to undergo open surgery, while 40 patients were randomized to the laparoscopic surgery,and the pathological stage is beyond stage III.In the surgery process, after opening the peritoneal cavity ,injected saline 500ML into the abdominal cavity from the incision and the poke, and collected the washing fluid. after resection of the tumor , injected saline 500ML into the abdominal cavity again, and collected too,at last washed the abdominal cavity with the mixture consisted by the 43 degree temperature distilled water 2000ml and 5- FU ,and finally all do the cytology examination and RT-PCR after filtration process , smear , fixation and staining.ResultsThe outcome of the expriment: (1) In all 80 patients,with the RT-PCR approach, the preoperative(before the tumor removed)positive rate was 15% and the postoperative (after the tumor removed)was 40%,while the preoperative positive rate was 7.5% and the postoperative was 17.5% which use the cytology .(p=0.02) (2) Detected by the cytology test,the positive rate was 7.5% of the preoperative and the postoperative was 17.5%, the distilled water +5- FU group was 0%.(p<0.05),Detected by RT-PCR,the positive rate was 15% of the preoperative and the postoperative was 40%, the distilled water +5- FU group was 0%.(p<0.05).(3) whatever the RT-PCR approach or the cytology test ,there is no significant difference between laparoscopic group and open group . (p>0.05)(4)The Histological type had something to do with the exfoliated tumor cells.(p<0.05),but the the exfoliated tumor cells had nothing to do with the clinical pathological stage.Conclusions(1) The RT-PCR approach was more sensitive than the cytology, and improved the positive rate. (p<0.05)(2)Both the laparoscopic surgery and laparotomy may cause cancer cell dissemination and seeding.There is no significant clinical differences in shedding of tumor cells between the laparoscopic surgery group and laparotomy group. (p> 0.05), The CO2 pneumoperitoneum wasn't the main reason which caused the cancer metastasis,but contacted with surgical instruments, or surgery doctor who repeatedly touch, or even stretch, squeeze the tumor. (3) the mixture consisted by the 43 degree temperature distilled water 2000ml and 5- FU can effectively prevent cancer cell dissemination and seeding.(4) The Histological type had something to do with the exfoliated tumor cells(p<0.05),but the pathologic stage had no significant differences with exfoliated tumor cells,and it may be caused by the few cases or stage I patients.