Furuya Shinji, Shiraishi Kensuke, Shimizu Hiroki, Takiguchi Koichi, Sudo Makoto, Hidenori Akaike, Kawaguchi Yoshihiko, Amemiya Hidetake, Kondo Tetsuo, Ichikawa Daisuke
First Department of Surgery, Faculty of Medicine University of Yamanashi Chuo Japan.
Division of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kyoto Japan.
Ann Gastroenterol Surg. 2024 Aug 30;9(1):137-144. doi: 10.1002/ags3.12851. eCollection 2025 Jan.
This study aimed to determine the necessity of intraluminal washout through cytological assessment to prevent implantation of exfoliated cancer cells (ECCs) in patients with rectal and sigmoid cancers.
We studied 140 patients with either sigmoid or rectal cancer who underwent anastomosis surgery using a double-stapling technique. An intraluminal washout sample was collected before and after irrigation with 1000, 1500, or 2000 mL of physiological saline or distilled water. Cytological assessments were conducted using the Papanicolaou classification system, where classes IV and V indicated positive cytological findings.
Initially, 46.4% of the patients (65 out of 140) had positive ECCs. Patients with cancer cells had a significantly shorter distal free margin (DM) from the tumor ( < 0.001). The length of the DM was significantly associated with the tumor distance from the anal verge ( < 0.001). After irrigation with 2000 mL, ECCs were found in only 7.3% of patients. Logistic regression analysis showed that DM (≤50 mm) and tumor size (≥50 mm) were independent risk factors for positive ECCs after intraluminal washout, regardless of the type of irrigation solution used.
In patients with sigmoid colon cancer, adequate preoperative bowel preparation, a long DM, and a small tumor size, a 1000 mL intraluminal washout may be sufficient. By contrast, in patients with rectal cancer with a short DM and a large tumor size, a ≥2000 mL intraluminal washout is required. The different types of irrigation solution did not affect the ECCs. Large randomized controlled trials are required to confirm these results.
本研究旨在通过细胞学评估确定腔内冲洗在预防直肠癌和乙状结肠癌患者中脱落癌细胞（ECCs）种植方面的必要性。
我们研究了140例接受双吻合器技术吻合手术的乙状结肠癌或直肠癌患者。在用1000、1500或2000 mL生理盐水或蒸馏水冲洗前后收集腔内冲洗样本。使用巴氏分类系统进行细胞学评估，其中IV级和V级表明细胞学检查结果为阳性。
最初，46.4%的患者（140例中的65例）ECCs呈阳性。癌细胞患者距肿瘤的远端切缘（DM）明显较短（<0.001）。DM的长度与肿瘤距肛缘的距离显著相关（<0.001）。用2000 mL冲洗后，仅7.3%的患者发现ECCs。逻辑回归分析表明，无论使用何种冲洗液类型，DM（≤50 mm）和肿瘤大小（≥50 mm）是腔内冲洗后ECCs阳性的独立危险因素。
对于乙状结肠癌患者，术前充分的肠道准备、较长的DM和较小的肿瘤大小，1000 mL腔内冲洗可能就足够了。相比之下，对于DM短且肿瘤大的直肠癌患者，需要≥2000 mL腔内冲洗。不同类型的冲洗液对ECCs没有影响。需要大型随机对照试验来证实这些结果。
