title: Unique localization of circulating tumor cells in patients with hepatic metastases.
abstract: OBJECTIVE
  There are few data on the impact of immediate and differing surgical interventions on circulating tumor cells (CTCs), nor their compartmentalization or localization in different anatomic vascular sites.
  
  
  METHODS
  CTCs from consecutive patients with colorectal liver metastases were quantified before and immediately after open surgery, laparoscopic resection, open radiofrequency ablation (RFA), or percutaneous RFA. For individuals undergoing open surgery, either hepatic resections or open RFA, CTCs were examined in both systemic and portal circulation by measuring CTCs in samples derived from the peripheral vein, an artery, the hepatic portal vein, and the hepatic vein.
  
  
  RESULTS
  A total of 29 consecutive patients with colorectal liver metastases with a median age of 55 years (range, 30 to 88 years) were included. CTCs were localized to the hepatic portosystemic macrocirculation with significantly greater numbers than in the systemic vasculature. Surgical procedures led to a statistically significant fall in CTCs at multiple sites measured. Conversely, RFA, either open or percutaneous, was associated with a significant increase in CTCs.
  
  
  CONCLUSIONS
  Surgical resection of metastases, but not RFA, immediately decreases CTC levels. In patients with colorectal liver metastases, CTCs appear localized to the hepatic (and pulmonary) macrocirculations. This may explain why metastases in sites other than the liver and lungs are infrequently observed in cancer.
authors.affiliation: Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College/Imperial Healthcare National Health Service Trust, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Rd, 1st Floor, East Wing, London, United Kingdom W6 8RF.
authors.forename: Long R
authors.initials: LR
authors.lastname: Jiao
authors.forename: Christos
authors.initials: C
authors.lastname: Apostolopoulos
authors.forename: Jimmy
authors.initials: J
authors.lastname: Jacob
authors.forename: Richard
authors.initials: R
authors.lastname: Szydlo
authors.forename: Natalia
authors.initials: N
authors.lastname: Johnson
authors.forename: Nicole
authors.initials: N
authors.lastname: Tsim
authors.forename: Nagy A
authors.initials: NA
authors.lastname: Habib
authors.forename: R Charles
authors.initials: RC
authors.lastname: Coombes
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods; D015179:Colorectal Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000097:blood / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000187:drug effects / Q000473:pathology*; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome