Risk Of Tumor Cell Dissemination Research Articles

Vein-first versus artery-first ligation procedure for lung cancer surgery: An updated review

BackgroundThe optimal sequence of pulmonary vessel interruption during lung cancer resection remains controversial. This review aimed to elucidate the association of vein-first versus artery-first ligation and survival of the patients.MethodsWe searched PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar from their inception to September 2021 for published articles that compared vein-first (the pulmonary vein was interrupted first) and artery-first procedure (the pulmonary artery was ligated first) during lung cancer surgery.ResultsFinally, a total of 13 full articles were obtained. First, 7 studies with survival information were included for meta-analyses. As compared with the artery-first ligation, vein-first approach did not decrease the risk of local recurrence (risk ratio [RR] 0.92 in favour of vein-first; 95% confidence interval [CI] 0.61–1.39, p = 0.68) or distant metastasis (RR 0.92; 95% CI 0.30–2.85, p = 0.89); but it was associated with better disease-free survival (RR 0.52; 95% CI 0.37–0.73, p < 0.01) as well as 5-year overall survival (RR 0.60; 95% CI 0.41–0.86, p < 0.01). In addition, the operative time, intraoperative blood loss, total complications, and length of postoperative stay were mainly comparable between the two groups. Second, 7 studies provided the data of tumor cells indicated by different biomarkers and detection methods; and 3 of these reports showed that vein-first ligation decreased the extent of intraoperative tumor dissemination. However, a quantitative meta-analysis was not possible due to the significant heterogeneity.ConclusionVein-first ligation in lung cancer surgery may be associated with improved survival of the patients, which might be ascribed to potentially lower risk of tumor cell dissemination. Well-designed, large-scale trials are warranted to clarify these occasional findings.

Vein-first vs artery-first surgical technique for lobectomy of non-small cell lung cancer: A protocol for systematic review and meta-analysis.

Background:The operation of lung cancer may squeeze the tumor and further promote the spread of tumor cells to the circulation, which may be one of the reasons for the metastasis and recurrence of lung cancer. The potential risk of tumor cell dissemination can theoretically be minimized if the effluent veins were ligated first (via the vein-first [V-first] technique), instead of having the artery ligated first (via the artery-first [A-first] technique). However, this technical concept has not yet been widely accepted as a standard of surgical oncology in current guidelines owing to a lack of sufficient evidence. This systematic review and meta-analysis will be performed to determine which technique during lobectomy will achieve longer patient survival and be more beneficial for patients.Methods:We will search PubMed, Web of Science, EMBASE, Cancerlit, the Cochrane Central Register of Controlled Trials, and Google Scholar databases for relevant clinical trials published in any language before October 1, 2020. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, tumor pathological stage, and ethnicity will be performed. INPLASY registration number: INPLASY202050060.Results:The results of this study will be published in a peer-reviewed journal.Conclusion:As far as we know, this study will be the first meta-analysis to compare the efficacy of the vein-first and artery-first surgical technique of lobectomy for patients diagnosed with resectable non-small cell lung cancer. Due to the nature of the disease and intervention methods, randomized controlled trials may be inadequate, and we will carefully consider inclusion in high-quality, non-randomized controlled trials, but this may result in high heterogeneity and affect the reliability of the results.

Safety of Islet Autotransplantation After Pancreatectomy for Adenocarcinoma.

Total pancreatectomy with intraportal islet autotransplantation (TPIAT) rather than partial pancreatectomy could represent a major shift in the management of patients with resectable pancreatic ductal adenocarcinoma (PDAC) when risks of postoperative pancreatic fistula are well identified. This approach provides a theoretical risk of tumor cell dissemination when islet cells are transplanted into the portal vein. Our objective was to explore the safety of TPIAT in PDAC in a mouse preclinical model of subcutaneous xenotransplantation of human cells isolated from pancreatic specimen during partial pancreatectomy performed for PDAC. Patients requiring pancreatectomy for PDAC were prospectively included. Immunocompromised mice were transplanted with pancreatic cells isolated from the nonmalignant part of the surgical specimen (experimental group). Results were compared with pancreatic tumor implants (control group). Pancreatic grafts were explanted at 6 weeks for histological analyses. Nine patients were included, and 31 mice were transplanted. In the experimental group, explants were microscopically devoid of tumor cell, and no metastasis was observed. In the control group, all explants were composed of tumor. We report in a preclinical model the absence of local and distant spreading of malignant cells after pancreatic islets xenograft isolated from PDAC patients. These data supports the oncological safety of TPIAT as valuable alternative to partial pancreatectomy for PDAC patients with a high risk of postoperative pancreatic fistula.

Expression of epithelial marker CK19 in mice with mammary adenocarcinoma afterexposure to fito-anti-estrogen secoisolariciresinol

Introduction.Phyto-anti-estrogen secoisolariciresinol (SECO) has similar effectiveness to that of Tamoxifen (TAM), a member of selection estrogen receptor modulators, in estrogen-positive models of murine mammary adenocarcinoma and human breast cancer in vivo. Due to its antagonistic and agonistic functions Tamoxifen may enhance risk of development of uterine adenocarcinoma while providing effective prophylactics of breast cancer metastases. SECO effect on proliferative activity of circulating or disseminating tumor cells (occult metastases) is still unclear. We used epithelial cell marker – intracellular cytokeratin 19 (CK19) to study SECO function in terms of possible metastatic process, since prognostic significance of CK19 is well established for identifying occult metastases and breast cancer dissemination.Objective.To evaluate risk of tumor cell dissemination in mice with transplanted mammary adenocarcinoma after exposure to SECO and TAM.Materials and methods.Mice BDF 1 [C57Bl6j × DBA2] bearing Са755 of the 3rd passage were used for the experiments. CK19 expression was evaluated 24 hours after 10-day course of SECO in the effective single doses of 250 mg/kg or ТАM 50 mg/kg. Flow cytometry, immunofluorescence with light and luminescence microscopy were performed to evaluate CK19 expression.Results.Parameter GMFI ± SD (geometric mean fluorescence intensity ± SD) for CK19 expression in SECO and TAM groups in blood accounted for 28.87 ± 13.70 and 28.02 ± 9.50 and in control tumor growth (CTG) group GMFI ± SD was 31.94 ± 5.02; while in bone marrow it was 30.14 ± 2.33, 39.07 ± 2.30 and 32.48 ± 3.75, respectively.Conclusion.The results of the study showed similar expression of epithelial intracellular marker CK19 in blood in the studied groups of mice bearing mammary adenocarcinoma Ca755 sensitive to SECO and TAM exposure. GMFI for CK19 expression in bone marrow was lower in SECO group than in TAM (р = 0.0003). The data obtained in the murine model demonstrated no enhanced risk of tumor cell dissemination while performing treatment by phyto-anti-estrogen SECO in therapeutic regimen.

The risk of tumor cell dissemination in mediastinoscopy: a cytological study.

Mediastinoscopy is an invasive procedure that is used in the diagnosis of mediastinal diseases and in staging lung cancer. Tumor cell seeding during mediastinoscopy along the mediastinum and the incision line is a very rare complication. This study aimed to test the safety of mediastinoscopy in terms of tumor seeding by cytological evaluation of mediastinal lavage samples taken before and after biopsy. The patients who underwent mediastinoscopy in our hospital between 2011 and 2014 were studied prospectively. Seventy-three patients with a diagnosis of lung or mediastinal malignancy were included in the study. All patients underwent classical cervical mediastinoscopy and mediastinal lavages were taken before and after the biopsy. Both lavage samples were sent to the pathology department in syringes for malignant cell cytology screening. The results of the histopathological examinations of lymph node biopsies were reactive in 25 patients and positive for malignancy in 48 patients. In 2 of 48 patients whose lymph nodes were reported to be positive for malignancy, the mediastinal lavage sample was reported to be positive for malignancy after biopsy, although it was negative preoperatively. In two patients, both the pre- and postbiopsy lavage samples were reported to be positive for malignancy. While performing dissection and biopsy during mediastinoscopy, tumor seeding into the mediastinum may occur. Long follow-up periods and large patient series are needed to determine how cytopathological examination of both fluids would affect the prognosis.

Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters – a case series

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.

Surgical treatment strategy for cT4bM0 colon cancer

Colon cancer may invade the adjacent organ in the absence of distant metastasis, which is called stage T4bM0 colon cancer according to the 7th edition of TNM staging system. It is not rare in clinical setting, and usually recognized intraoperatively. How to deal with this situation is a big challenge for the surgeons. It is difficult to distinguish between dense adhesion and cancerous invasion. Intraoperative biopsy should be avoided because of the risk of tumor cell dissemination and frozen often gives false-negative results. After evaluating the resectability of the tumor sufficiently, the surgeon should make every effort to do an en bloc multivisceral resection and to achieve a margin-free (R0) resection if there is no absolute contraindication. This effort will bring long-term prognosis benefit for the patients with stage cT4bM0 colon cancer.

Utility of Percutaneous Image-Guided Biopsy to Diagnose Intraabdominal Lymphoma with Coaxial Core Needles,

Abstract 4214 Introduction:Although pathological diagnosis is an essential component of managing malignant lymphoma and other malignancies, intraabdominal lesions are generally difficult to approach due to the invasiveness of abdominal surgery. We report here the use of percutaneous image-guided coaxial core needle biopsy to obtain intraabdominal specimens. The coaxial method is associated with a lower risk of tumor cell dissemination and allows for repeated biopsies and thus improves the accuracy of pathological or immunohistological diagnosis. To the best of our knowledge, there have been no reports on the feasibility of this technique for diagnosing intraabdominal malignant lymphomas, which typically requires flow cytometry analysis as well as histopathological evaluation. Methods:We retrospectively reviewed consecutive cases involving percutaneous image-guided biopsy to obtain pathological specimens for intraabdominal mass lesions from April 1999 to March 2011 at Nagano Red Cross Hospital, Nagano, Japan. Liver, spleen, kidney, and inguinal node biopsies were excluded. Following local anesthesia, a certified interventional radiologist performed the procedures using a 16 coaxial guide needle (Cook) parallel to the anesthetic needle under computed tomography (CT) or ultrasonography (US). An 18 gauge core needle was inserted to obtain a pathological specimen, following aspiration with a 20 gauge needle for flow cytometry and cytological evaluation. Occlusion materials of the biopsy track were not used. Since laparotomic biopsy was performed for intraabdominal lesions when percutaneous needle biopsy was not indicated due to anatomical difficulties, we compared needle biopsies with simultaneously performed laparotomic biopsies, which led to a diagnosis of lymphoma. Results:During the 12-year period, we performed 66 procedures for 60 patients (32 males, 28 females; median age, 63.5; age range, 16–85). Six patients underwent second or third repeat procedures due to prior inappropriate samplings (5) or relapse (1). The overall diagnostic rate was 86.4% (57/66); there were 56 true positives, 1 true negative, 9 false negatives, and no false positives (sensitivity, 85.9%; specificity, 100%). No patients required additional surgical biopsies. CT and US were used in 51(76%) and 16 (24%) procedures, respectively. There was no statistically significant difference in accuracy between CT and US as an imaging modality. Notably, median interval between recognition of intraabdominal mass and biopsy was only one day (0–24). As for hematological malignancies, 39 patients had malignant lymphoma (diffuse large B cell lymphoma, 16; follicular lymphoma, 12; Hodgkin lymphoma, 3; peripheral T cell lymphoma, 3; small lymphocytic lymphoma, 3; Burkitt lymphoma, 1; extranodal NK/T cell lymphoma, nasal type, 1) including one case with relapse; 45 procedures were performed for these patients. Biopsies were submitted in 43 procedures, and adequate specimens were obtained for histopathological evaluation and diagnosis in 37 (86%). Flow cytometry was used in 39 procedures and detected lymphoma cells in 31 (79.5%). No major adverse events were observed. Twelve patients (9 males and 3 females; median age, 60; age range, 42–72) were eligible for laparotomic biopsy. While every postoperative course was satisfactory, median duration from lesion recognition to therapy initiation for lymphoma cases excluding those who chose watchful wait or refused therapy was significantly shorter for needle biopsies than laparotomy (14 versus 35 days, p<0.001). Conclusions:This is the first report to show the clinical effectiveness of percutaneous image-guided intraabdominal needle biopsy with coaxial core needles for diagnosis of intraabdominal lymphomas. Although no difference was previously reported between coaxial and noncoaxial methods for liver or kidney biopsies (Hatfield et al. AJR 2008), they experienced seven (0.9%) major complications including one death. We identified no major complications using the Cook core needle system in the present study. This method significantly improves the collection of adequate specimens from intraabdominal lymphoma lesions and potentially helps attain immunohistological distinction, allowing for more timely therapy initiation. Disclosures:No relevant conflicts of interest to declare.

Papillary Thyroid Carcinoma Mimicking Anaplastic Thyroid Carcinoma Following Fine-Needle Aspiration Biopsy

Cutaneous metastases from well-differentiated thyroid carcinomas are rare and usually identified in patients with widely disseminated disease. Fine-needle aspiration biopsy (FNAB) has become an acceptable method for the assessment of thyroid nodules. Very rarely needle track dissemination of tumor cells in the thyroid nodule occurs, but, when this occurs, it is evident many years after the FNAB. We report a patient who appears to have tumor dissemination from an FNAB needle track only 4 months after the procedure. An 85-year-old female presented with a mass on her neck, skin ulceration, and hemorrhage 4 months after FNAB was performed for a thyroid nodule by another physician. A second FNAB with ultrasound guidance yielded cytology diagnostic of papillary thyroid carcinoma. Papillary thyroid carcinoma was confirmed by surgical dissection of the mass, and a linear array of tumor was noted in skin and muscle was performed again, and the cytological diagnosis revealed papillary carcinoma. After surgical resection, the histopathological diagnosis determined the nodules to be papillary carcinoma. Metastatic deposits appeared in the skin and the muscle. The linear array and the site of metastases implied that seeding most probably resulted from the needle biopsy. Although FNAB is a useful tool for the diagnosis of thyroid nodules, it is important to consider the risk of tumor cell dissemination.

Needle Track Dissemination of Follicular Thyroid Carcinoma Following Fine-Needle Aspiration Biopsy: Report of a Case

Few reports have been concerned with the risk of needle track dissemination of tumor cells following fine-needle aspiration biopsy, especially for follicular thyroid nodules. A 61-year-old woman who underwent fine-needle aspiration biopsy and surgery 5 years previously for follicular thyroid adenoma presented with nodules that had developed in the sternocleidomastoid and omohyoid muscles of the anterior neck. These nodules were located along a line from the skin to the thyroid that coincided with the needle track of the previous biopsy. Following surgical resection, histological diagnosis determined the nodules to be follicular carcinoma. The clinical course and linear arrangement of the lesions were highly suggestive of needle track dissemination of tumor cells following fine-needle aspiration biopsy. Although fine-needle aspiration biopsy is a useful tool for the diagnosis of thyroid nodules, it is important to consider the risk of tumor cell dissemination.

3. Internationales Symposium: „Autologe Transfusion - Von der Euphorie zur Ratio: Praktisches Handeln aus wissenschaftlicher Sicht” (Teil II)Relevante Aspekte bei der Bestrahlung und Retransfusion von maschinell aufbereitetem Wundblut - aus anästhesiologischer Sicht

The requirement for intraoperative blood salvage (IBS) in cancer surgery stems from the high transfusion rate, the unfavourable effects of an anaemia, and the impact of transfusion risks like immunomodulation in tumor patients. The advantages of IBS are availability, the low waste rate, and the excellent quality of this autologous, unstored blood. The only effective elimination of the risk of tumor cell dissemination after retransfusion of wound blood is achieved by blood irradiation. The combination of the established methods of IBS and blood irradiation is practical, and allows a very efficient saving of blood. For Jehovah's witnesses it may open the possibility for tumor surgery. From an anaesthesiological point of view it is part of the therapy, but any context that puts it compatible to medicolegal regulations is welcome. For him as the one responsible for the therapy of intraoperative blood loss it represents the safest and best blood for an optimal hemotherapy in tumor patients. In addition, first data indicate a better outcome of these patients.

Section 3. Adrenal: Laparoscopic surgery for malignant adrenal tumors

This paper outlines the indications and techniques of laparoscopic surgery for malignant adrenal tumors. Laparoscopic surgery is not indicated for adrenal tumors of any size when invasion of the surrounding tissues is clearly detected by preoperative imaging. When laparoscopic surgery is performed for a tumor without invasion that has a maximum diameter of more than 6 cm or a tumor that is considered potentially malignant from preoperative imaging or endocrine studies, it is important to inform the patient and family that the tumor may be malignant and that conversion to open surgery may be necessary. The transperitoneal approach is appropriate for primary adrenal malignancies. For metastatic cancer, the transperitoneal approach is suitable for radical surgery and the extraperitoneal approach for histological diagnosis by partial resection or tumor biopsy. In either case, it is important for the surgeon to have a sufficiently wide working space, to remove the tumor and surrounding fat en bloc, to never grasp the tumor or adrenal tissue, and to carefully handle the ultrasonically activated scalpel or ultrasonic aspirator so that it does not touch the tumor surface due to the risk of tumor cell dissemination. It is also essential not to unreasonably persist with laparoscopic procedures, but to immediately switch to open surgery when laparoscopic surgery becomes difficult.

Experiences with drill biopsy in the diagnosis of breast tumors

We report on our experiences of 598 drill biopsies in 581 female patients. The method is suitable for clarification of dubious palpatory findings in the breast, for verification of relapse, and for receptor analysis in individual cases. It is simple to carry out, almost free of complications and provides sufficient tissue for rapid-section diagnostics. It has a high precision (90% to 92%): no false positive results were noted. The advantage, compared to excision biopsy, consists of the shortening of the duration of operation and anesthesia and better diagnostic clarification. The problem of the excision cavity is avoided. In case of a mastectomy or quadrantectomy, the primary tumor and remains connected with the tissue surrounding the tumor is available in toto for histological examination. The risk of tumor cell dissemination from drillbiopsy did not appear to be increased. The limitations of the method apply to small (less than 1 cm) not definitely palpable tumors near to the thorax wall in large, voluminous breasts. The diagnosis of specific histological types requires a high degree of experience in ultrastructural appraisal of breast tissue. A negative drill biopsy should be followed by an excision biopsy, where a carcinoma is suspected.