SAN DIEGOIt has been suggested that laparoscopic surgical
techniques may increase malignant cell spread, due primarily to
peritoneal insufflation. A study conducted at the Colorectal Cancer
Unit, Institut de Malalties Digestives, Hospital Clinic, Barcelona,
Spain, has found that the type of surgery is not a determining factor
in colorectal cancer spread.
Xavier Bessa, MD, a research fellow at the Hospital Clinic, reported
the results at the plenary session of the Society for Surgery of the
Alimentary Tract meeting held during Digestive Disease Week.
Our aim was to investigate the potential harmful effect
laparoscopic surgery may have, he said. Now that we are
able to detect neoplastic cells in human biologic samples, we could
evaluate the effect of surgery on tumoral dissemination by comparing
lapa-roscopic-assisted colectomy with open colectomy.
Dr. Bessa and his colleagues randomly assigned 50 consecutive
nonmetastatic colorectal cancer patients to laparoscopic-assisted
colectomy (26) or open colectomy (24). Peripheral venous blood
samples were collected before the procedure as a baseline,
immediately after the procedure, and then 24 hours after surgery.
In a subgroup of 20 patients, divided evenly between the two
procedures, portal blood and peritoneal fluid samples were obtained
both at the start and the end of surgery.
Dr. Bessa explained that neoplastic cells were detected by means of
reverse transcriptase-polymerase chain reaction (PCR) targeted to
carcinoembryonic antigen (CEA) mRNA.
Before surgery, CEA mRNA expression was detected in peripheral blood
from 35 patients, 20 from the lapa-roscopic-assisted colectomy group
and 15 from the open colectomy group. In preoperatively negative
patients, CEA mRNA expression was detected at the end of surgery in
three of six laparoscopic patients, and in two of eight open surgery patients.
Conversion persisted 24 hours after surgery in all open colectomy
patients and in two cases from the laparoscopic group. Before tumor
mobilization, portal blood CEA mRNA expression was detected in seven
patients from the laparoscopic group and in eight from the open
In addition, while baseline peritoneal fluid CEA mRNA expression was
not detected in any patient, one case from each group became positive
following surgery. None of the differences between groups reached
We concluded that while preoperative and perioperative
dissemination of tumor cells is frequent in colorectal cancer, the
surgical approach does not seem to be a determining factor, Dr.