Keiner Doerthe, Heimann Axel, Kronfeld Andrea, Sommer Clemens, Mueller-Forell Wibke, Kempski Oliver, Oertel Joachim
Department of Neurosurgery, University Medical Center Saarland, Homburg-Saar, Germany.
Institute of Neurosurgical Pathophysiology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany.
Clin Neurol Neurosurg. 2016 Jul;146:57-63. doi: 10.1016/j.clineuro.2016.04.009. Epub 2016 Apr 24.
While clinically the safety and efficacy of waterjet resection of brain tumors have been shown, evidence that waterjet dissection improves tumor resection radicality in comparison with conventional techniques is still missing. In the present study, resection radicality and tumor-free long-term survival of both techniques were evaluated in a C6-glioma model.
Fifty-thousand C6-glioma cells were stereotactically transplanted in the left frontal lobe of 100 male Sprague-Dawley rats. After MRI-scanning for evaluation of tumor extension, microsurgical tumor resection was performed with conventional techniques (n=50) or with the waterjet dissector at pressures of 6bar (n=50). Twenty-five animals of each group were sacrificed after surgery for histological analysis. For analysis of survival after tumor resection, twenty-five animals of each group were followed-up to analyze tumor-free survival using the Kaplan Meier method.
In the waterjet group, the resection cavity was free of C6-tumor cells in 10/25 (40%) rats showing a trend (p=0.3) towards better resection radicality compared to the rats that were treated conventionally (7/10; 28%). R1-resection with up to 250C6 cells/object slice was found in 14/25 (56%) rats after waterjet dissection compared to 6/25 (24%) rats treated conventionally showing significance (p<0.01). Probability of survival was 38% after 2 weeks and 20% after 6 months in the waterjet group compared to 30% and 16% respectively in the conventional group. Diffuse tumor cell spreading with possible influence on survival was shown in 47/50 rats.
In this experimental model, waterjet tumor resection did reveal significantly better resection radicality compared to the conventional technique. Although a direct transfer of these results to human glioma surgery is prohibited, the waterjet technique might contribute to the best possible resection radicality in human gliomas. Nevertheless, tumor cell spreading remains a major problem. Further studies have to address that the surgical results - in deed - improve the postoperative outcome.
虽然临床上已证明水刀切除脑肿瘤的安全性和有效性，但与传统技术相比，水刀分离能提高肿瘤切除彻底性的证据仍然缺乏。在本研究中，在C6胶质瘤模型中评估了两种技术的切除彻底性和无瘤长期生存率。
将50000个C6胶质瘤细胞立体定向移植到100只雄性Sprague-Dawley大鼠的左额叶。在进行MRI扫描以评估肿瘤范围后，采用传统技术（n=50）或在6巴压力下使用水刀分离器（n=50）进行显微手术肿瘤切除。每组25只动物在手术后处死进行组织学分析。为了分析肿瘤切除后的生存率，每组25只动物进行随访，采用Kaplan Meier方法分析无瘤生存率。
在水刀组中，10/25（40%）的大鼠切除腔内无C6肿瘤细胞，与传统治疗的大鼠（7/10；28%）相比，显示出切除彻底性更好的趋势（p=0.3）。水刀分离后，14/25（56%）的大鼠实现了R1切除，每切片标本中C6细胞最多250个，而传统治疗的大鼠为6/25（24%），差异有统计学意义（p<0.01）。水刀组2周后的生存率为38%，6个月后的生存率为20%，而传统组分别为30%和16%。47/50的大鼠出现弥漫性肿瘤细胞扩散，可能影响生存率。
在本实验模型中，与传统技术相比，水刀肿瘤切除的切除彻底性明显更好。尽管这些结果不能直接应用于人类胶质瘤手术，但水刀技术可能有助于在人类胶质瘤中实现尽可能好的切除彻底性。然而，肿瘤细胞扩散仍然是一个主要问题。进一步的研究必须解决手术结果确实能改善术后结局这一问题。
