Detection of Intra-peritoneal Free Cancer Cell during Laparoscopic Staging of Patients with Advanced Gastric Carcinoma / 대한소화기내시경학회지

BACKGROUND/AIMS: Peritoneal dissemination is the most frequent type of recurrence in gastric cancer after curative surgery. Such recurrences may be attributable to possible intra-peritoneal dissemination of malignant cells. The aim of this study was to investigate the role of diagnostic laparoscopy and peritoneal lavage cytology to detect intra-peritoneal dissemination pre-operatively in the staging of advanced gastric cancer. METHODS: Laparoscopy and peritoneal lavage was performed in patients with advanced gastric adenocarcinoma after noninvasive staging had shown no irresectable locoregional disease and/or distant metastases. The peritoneal cavity was washed and allowed to collect during laparoscopic examination and stained by Papanicolaou methods. The results were compared with TNM stage, size of cancer, endoscopic diagnosis, and histologic type. RESULTS: Thirty-three patients were included. Peritoneal metastasis and intra-peritoneal free cancer cells were proven histo/ cytologically in seven patients (21.2%) and cytologically only in three patients (9.1%). All of these patients were stage IIIB or stage IV and showed higher stages than cytologically negative patients (p<0.01). CONCLUSIONS: Laparoscopic staging in advanced gastric cancer patients may be a good diagnostic method to detect intra-peritoneal dissemination. Detection of intra-peritoneal free cancer cells may suggest more advanced stage of gastric cancer. Peritoneal lavage cytology may be used to predict a serosal or direct invasion to adjacent organs.

To study the free cancer cells in the surgical field and prevention of local recurrense of breact cancer with hyperthermic soaking chemocherapy / 临床外科杂志

Objective Through the qualitative study of surgical field free cancer cells of patients with breast cancer,to evaluate theprevention effects of intraoperative hot hypotonic solution soaking chemotherapy on cancer recurrence after resection of breast cancer.Methods 94 cases with breast cancer divided in to study group (n=48)and control group (n=46).Before the operation wound closed,both group surgical field washing solutions were collected for examination of free cancer cell,then the wounds of study group were treated with Hyperthermic soaking chemotherapy (41℃～42℃normal saline solutions 3000 ml+5-fluorouracil 1.0 g),once five minutes,total 3～4 times.While the wound of control group were soaked with normal saline solutions only.The soaking solutions were collected for examination of free cancer cell.The rates of free cancer cell in the surgical field and local recurrence rates in the both group were compared.Result The rates of washing solutions and the rates of soaking solution and the localy recurrent rates in the study group were 29.2%,8.3%,6.3%,which in the control group were 26.1%,19.6%,15.2%.Conclusions There are free cancer cells in the surgical field of breast cancer.Hyperthermic soaking chemotherapy can kill free cancer cell and reduce localy recurrent rate.

Clinical Significance of Intraperitoneal Free Cancer Cells in Prognosis and Treatment of Gastric Cacner

Peritoneal lavage cytology was performed at the time of gastrectomy for 295 patients with gastric cancer from September 1991 to January 1996 in the Department of Medical Sciences,Chonbuk National University Graduate School. The results were as follows;1) Positive intraperitoneal free cancer cells were observed in 9.8% of all case. And,the higher the S-category, the higher the increase in positive intraperitoneal free cancer cells, but the lower the rate of survival. 2) The higher the spatial extent of the invasion of the gastric serosa,the higher the increase in the positive intraperitoneal free cancer cells. However, There was no statiscal relation between the areas of gastric serosa invasion and the 3-year survival rate. But, especially when the areas of serosa invasion are 5-10cm2, the 3-year survival rate was statiscally higher in the negative intraperitoneal free cancer cell group than in the positive free cancer cell group.(P<0.012). 3) The rate of positive intraperitoneal free cancer cells become higher progressively with increasing the peritoneal invasion, but, there were no 3-year survival patients who have positive peritoneal invasion . In patients with no evidence of peritoneal spread, negative intraperitoneal free cancer cell group had a statistically signigficant higher 3-year survival rate than the positive group.(P<0.0004). 4) For histopathological types of tumors, the incidence of positive intraperitoneal free cancer cells was higher in undifferentiated adenocarcinomas than in differentiated types, though the difference was statistically insignificant. For signet-ring cell carcinomas, the 3-year survival rate of the negative intraperitoneal free cancer cell group was statistically higher than that of the positive group.(P<0.0005). 5) The incidence of positive intraperitoneal free cancer cells increased as the stage of gastric cancer increased, but the survival rate was decreased. 6) In the noncurative resection group, the incidence of positive intraperitoneal free cancer cells was higher, but the survival rate was lower, than in the curative resection group. The 3-year survival rates were higher for the patients with curative resection and negative intraperitoneal free cancer cells than for the patients with curative resection and positive intraperitoneal free cancer cells (P<0.0009). The difference in the 3-year survival rate between the noncurative resection with positive intraperitoneal free cancer cell group and the noncurative resection with negative intraperitoneal free cancer cell group was stastistically significant. (P<0.0000). 7) For the types of recurrence, hematogenous metastasis was the most common type of recurrence in the negative intraperitoneal free cancer cell group; peritoneal metastasis was the most common type of recurrence in the positive intraperitoneal free cancer cell group. In conclusion; at the time of gastrectomy, peritoneal lavage cystology is very impotant and basic examination which can help early detection of intraperitoneal free cancer cells. Therefore, when intraperitoneal free cancer cells are negative,radical curative gastrectoy make the high survival rate of patients.

STUDY OF DETECTABLE RATE OF FREE CANCER CELLS OF PATIENTS WITH GASTRIC CANCER / 解放军医学杂志

Through the qualitative study of peritoneal cavity free cancer cells of patients with gastric cancer, to evaluate the rational of exercising intraoperative no touch isolation technique, routine peritoneal and warm perfusion chemotherapy after the operation. 102 patients in PLA 309 Hospital with gastric cancer were included into the study. 100 ml peritoneal fluid were collected respectively before the investigation and before close peritoneal cavity,and rapidly sent for free cancer cells examination. Results: Before the investigation, the positive rate of free cancer cells is 36.3%, and the positive rate before close peritoneal cavity is 52.9%. The free cancer cells positive rate is concerned with tumor infiltration depth, serous membrane infection area and the type of the histopathology。Conclusions: Inside the peritoneal cavity of patients with gastric cancer, free cancer cells are able to survive and have a high degree of activity. Although all kinds of intraoperative no touch isolation technique are used, it still cannot be avoided that some cancer cells will exfoliate and slip into the peritoneal cavity. The wound stimulation during the operation will certainly increase the exfoliation. So, it is quite necessary in the course of operation to adopt no touch isolation technique and to use a great deal of normal saline to give peritoneal cavity lavage. And what's more important is, to give these patients who show positive in the free cancer cell examination perfusion chemotherapy after the operation.