Department of Emergency.
Gastroenterology Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning City, Guangxi Province, People's Republic of China.
Surg Laparosc Endosc Percutan Tech. 2021 Mar 31;31(4):399-403. doi: 10.1097/SLE.0000000000000930.
Some reports asserted that the stimulation of ultrasonic scalpel and the persistent state of carbon dioxide (CO2) pneumoperitoneum in laparoscopic surgery may affect the adhesion and invasion of gastric cancer (GC) cells. This study aimed to reveal the effects of laparoscopic radical gastrectomy on peritoneal micrometastases (PM) of GC.
Fifty-three patients who underwent laparoscopic radical gastrectomy for GC were enrolled in the study. The expressions of carcinoembryonic antigen (CEA) mRNA and dopa decarboxylase (DDC) mRNA in peritoneal lavage fluid were detected by reverse transcription-polymerase chain reaction. The positive rates of CEA mRNA and DDC mRNA in preoperative peritoneal lavage fluid (pre-CEA, pre-DDC) were compared with those in postoperative lavage fluid (post-CEA, post-DDC). The correlation between the expressions of pre-CEA and pre-DDC and clinicopathologic factors and disease-free survival was analyzed.
There was no significant difference in the positive rates of pre-CEA and pre-DDC compared with those of post-CEA and post-DDC (all P>0.05). The positive rates of pre-CEA and pre-DDC increased with the increase of TNM stage, deepening of invasion, lymph node metastasis, and serosal invasion (all P<0.05), but had no correlation with tumor location, size, degree of differentiation, nerve invasion, and vascular invasion (all P>0.05). The disease-free survival in the combined positive patients was lower than that in the negative patients.
Laparoscopic radical gastrectomy for GC is safe and feasible, without increasing the risk of PM. The PM of GC may be associated with late tumor stage, deep infiltration, lymph node metastasis, and serosal invasion.
一些报告声称，超声刀的刺激和腹腔镜手术中二氧化碳（CO2）气腹的持续状态可能会影响胃癌（GC）细胞的黏附和侵袭。本研究旨在揭示腹腔镜根治性胃切除术对 GC 腹膜微转移（PM）的影响。
本研究纳入了 53 例接受腹腔镜根治性胃切除术治疗 GC 的患者。采用逆转录-聚合酶链反应检测腹腔灌洗液中癌胚抗原（CEA）mRNA 和多巴脱羧酶（DDC）mRNA 的表达。比较术前腹腔灌洗液（pre-CEA、pre-DDC）和术后灌洗液（post-CEA、post-DDC）中 CEA mRNA 和 DDC mRNA 的阳性率。分析 pre-CEA 和 pre-DDC 的表达与临床病理因素和无病生存的相关性。
pre-CEA 和 pre-DDC 的阳性率与 post-CEA 和 post-DDC 的阳性率相比无显著差异（均 P>0.05）。pre-CEA 和 pre-DDC 的阳性率随 TNM 分期的增加、浸润深度的加深、淋巴结转移和浆膜侵犯的增加而增加（均 P<0.05），但与肿瘤位置、大小、分化程度、神经侵犯和血管侵犯无关（均 P>0.05）。联合阳性患者的无病生存率低于阴性患者。
腹腔镜根治性胃切除术治疗 GC 是安全可行的，不会增加 PM 的风险。GC 的 PM 可能与晚期肿瘤分期、深度浸润、淋巴结转移和浆膜侵犯有关。
