Laparoscopic Surgery Does Not Enhance Colon Cancer Spread

SAN DIEGO—It 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 surgery group.

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 statistical significance.

“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. Bessa said.