Abstract
BackgroundDuring oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.MethodsIn a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.ResultsAll patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.ConclusionsEffectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.
Highlights
During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood
In addition to preoperatively existing circulating tumor cells, manipulation of tumor tissue during oncologic surgery may result in an extra tumor cell release into the systemic blood circulation
Patients underwent extended liver surgery with leukocyte depletion filters integrated within the extra corporal venovenous bypass system
Summary
Intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. In many studies the prognostic relevance of circulating tumor cells in patients undergoing resection of primary and metastatic colorectal cancer has been demonstrated [1,2]. In addition to preoperatively existing circulating tumor cells, manipulation of tumor tissue during oncologic surgery may result in an extra tumor cell release into the systemic blood circulation. A simple method to prevent such perioperative cell dissemination in patients with primary colorectal cancer was described in the 1960’s, the so-called ‘no-touch’ surgery, with early vascular closure before preparation and resection [6]. Patients underwent extended liver surgery with leukocyte depletion filters integrated within the extra corporal venovenous bypass system
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