Hansen E, Wolff N, Knuechel R, Ruschoff J, Hofstaedter F, Taeger K
Department of Anesthesiology, University of Regensburg, Germany.
Arch Surg. 1995 Apr;130(4):387-93. doi: 10.1001/archsurg.1995.01430040049007.
To analyze blood shed from the surgical field during oncologic surgery for tumor cells and to assess functional characteristics of these cells.
Series of 61 patients with cancer who underwent surgery for an abdominal, orthopedic, urological, gynecological, or head and neck malignant tumor, and blinded comparison with 15 patients with benign diseases undergoing surgery.
A 500-bed tumor center and a tertiary care hospital.
Tumor cells were isolated from intraoperatively salvaged and washed blood by density gradient centrifugation. They were identified in cytospin specimens by their content of cytokeratins and nucleolar organizer regions with a sensitivity of 10 cells in 500 mL of blood. Clonogenicity was tested in a cell colony assay; invasiveness, in Boyden chambers; and tumorigenicity, in nude mice.
In 57 of 61 patients, tumor cells were detected in the blood shed during oncologic surgery. They demonstrated proliferation capacity, invasiveness, and tumorigenicity. The total number of tumor cells identified ranged from 1 x 10(1) to 7 x 10(6), with no close correlation to the amount of blood loss. Circulating tumor cells were demonstrated in only 26% of these patients and in small numbers.
Malignant cells identified regularly in the blood shed during tumor surgery and different from circulating tumor cells are of concern, since at the surgical site they may cause local tumor recurrence, or in the salvaged blood they may cause hematogenic metastasis after retransfusion. Therefore, the contraindication of intraoperative autotransfusion in tumor surgery is strongly supported, and a review of surgical procedures and adjuvant therapy may be indicated, as the passage of the identified cells to the shed blood is yet unknown.
分析肿瘤手术中手术野流出血液中的肿瘤细胞，并评估这些细胞的功能特性。
61例癌症患者系列，这些患者接受了腹部、骨科、泌尿外科、妇科或头颈恶性肿瘤手术，并与15例接受手术的良性疾病患者进行盲法比较。
一家拥有500张床位的肿瘤中心和一家三级护理医院。
通过密度梯度离心从术中回收并洗涤的血液中分离肿瘤细胞。通过细胞角蛋白和核仁组织区的含量在细胞涂片标本中鉴定肿瘤细胞，在500 mL血液中检测灵敏度为10个细胞。在细胞集落测定中测试克隆形成能力；在Boyden小室中测试侵袭性；在裸鼠中测试致瘤性。
61例患者中有57例在肿瘤手术期间流出的血液中检测到肿瘤细胞。它们表现出增殖能力、侵袭性和致瘤性。鉴定出的肿瘤细胞总数为1×10¹至7×10⁶，与失血量无密切相关性。这些患者中仅26%检测到循环肿瘤细胞，且数量较少。
肿瘤手术期间流出血液中经常鉴定出的恶性细胞与循环肿瘤细胞不同，令人担忧，因为在手术部位它们可能导致局部肿瘤复发，或在回收血液中再输血后可能导致血行转移。因此，强烈支持肿瘤手术中术中自体输血的禁忌证，并且可能需要对手术程序和辅助治疗进行审查，因为已鉴定细胞进入流出血液的途径尚不清楚。
