Arita Tomohiro, Ichikawa Daisuke, Konishi Hirotaka, Komatsu Shuhei, Shiozaki Atsushi, Hiramoto Hidekazu, Hamada Junichi, Shoda Katsutoshi, Kawaguchi Tsutomu, Hirajima Shoji, Nagata Hiroaki, Fujiwara Hitoshi, Okamoto Kazuma, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ann Surg Oncol. 2015 Mar;22(3):758-64. doi: 10.1245/s10434-014-4060-4. Epub 2014 Sep 9.
The association between intraoperative hemorrhage and the type of recurrence was examined, with a focus on peritoneal metastasis.
A total of 540 patients who underwent macroscopically curative gastrectomy for advanced gastric cancers were reviewed for various clinicopathological characteristics, such as the amount of intraoperative hemorrhage and the pattern of recurrence. Additionally, adhesion assays using gastric cancer cells and mesothelial cells were performed in the presence of blood plasma to assess its effects on cell adhesion.
Large intraoperative hemorrhages were correlated with a higher risk of peritoneal metastasis, while small hemorrhages were not. However, there were no significant differences in the incidence of all recurrences or other types of recurrence between both groups. Multivariate analysis of all cases (T2-4) revealed that large intraoperative hemorrhages were not an independent risk factor for peritoneal recurrence (p = 0.144); however, the large hemorrhage group developed peritoneal recurrence more frequently than the small hemorrhage group in each T stage. In the adhesion assay, the ability of cancer cells and mesothelial cells to adhere to each other was enhanced by the addition of plasma to the culture medium. The addition of heparin significantly decreased the plasma-induced enhancement of cell adhesion of Kato III, but not MKN45 or MKN74.
Advanced gastric cancer patients accompanied by a large amount of intraoperative hemorrhage are more likely to develop peritoneal recurrence, and this risk might be due, at least in part, to the increased ability of cancer cells and mesothelial cells to adhere to each other.
研究术中出血与复发类型之间的关联，重点关注腹膜转移。
回顾了540例行宏观根治性胃癌切除术的进展期胃癌患者的各种临床病理特征，如术中出血量和复发模式。此外，在血浆存在的情况下，使用胃癌细胞和间皮细胞进行黏附试验，以评估其对细胞黏附的影响。
术中大量出血与腹膜转移风险较高相关，而少量出血则不然。然而，两组在所有复发或其他类型复发的发生率上没有显著差异。对所有病例（T2-4）进行多因素分析显示，术中大量出血不是腹膜复发的独立危险因素（p = 0.144）；然而，在每个T分期中，大出血组比小出血组更频繁地发生腹膜复发。在黏附试验中，向培养基中添加血浆可增强癌细胞和间皮细胞相互黏附的能力。添加肝素可显著降低血浆诱导的Kato III细胞黏附增强，但对MKN45或MKN74无此作用。
术中出血量大的进展期胃癌患者更易发生腹膜复发，这种风险可能至少部分归因于癌细胞和间皮细胞相互黏附能力的增强。
