Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan.
International Medical Center, Fujita Health University Hospital, 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Surg Today. 2020 Dec;50(12):1652-1656. doi: 10.1007/s00595-020-02064-w. Epub 2020 Jul 2.
To investigate the frequency of exfoliated cancer cells and the efficacy of rectal washout during intersphincteric resection (ISR) in patients not receiving chemoradiotherapy (CRT) for very low rectal cancer.
The subjects of this prospective study were 16 consecutive patients who underwent ISR without CRT for very low rectal cancer. Brushing cytology of the posterior anorectal wall was performed twice in each step of the ISR procedure and the samples were sent for blind cytological examination to identify exfoliated cancer cells.
Exfoliated cancer cells were identified in 9 of 13 patients (69%) preoperatively. The number of cancer cells identified after abdominal total mesorectal dissection decreased significantly from 94% (15/16) to 25% (4/16) after transanal irrigation with 2000 mL saline (p < 0.001). No cancer cells were identified after swabbing the anal wall following transanal dissection with purse-string closure of the distal stump. No suture-line recurrence was found during a median follow-up duration of 6 years.
Exfoliated cancer cells, confirmed in 94% of patients after total mesorectal excision, could be eliminated by performing rectal irrigation after clamping the rectum proximal to the tumor and swabbing the anorectal wall during ISR.
探讨未接受放化疗的超低位直肠癌患者行括约肌间切除术（ISR）时脱落癌细胞的频率和直肠冲洗效果。
本前瞻性研究的对象为 16 例因超低位直肠癌而行 ISR 且未接受放化疗的连续患者。在 ISR 手术的每一步中，对后肛直肠壁进行两次刷检细胞学检查，并将样本进行盲法细胞学检查，以识别脱落的癌细胞。
术前有 13 例（69%）患者可识别脱落癌细胞。与术前相比，经腹部全直肠系膜切除术后，经 2000ml 生理盐水经肛门冲洗后，癌细胞数量从 94%（15/16）显著减少至 25%（4/16）（p<0.001）。荷包缝合关闭远端残端后，经肛门分离并擦拭肛管壁，未发现癌细胞。中位随访 6 年，未见吻合口复发。
在全直肠系膜切除术后，94%的患者可确认脱落癌细胞，通过在肿瘤近端夹闭直肠并在 ISR 时擦拭肛管壁进行直肠冲洗，可以消除脱落癌细胞。
