title: Exfoliated malignant cells at the anastomosis site in colon cancer surgery: the impact of surgical bowel occlusion and intraluminal cleaning.
abstract: OBJECTIVE
  Exfoliated malignant cells, present along staple lines of anastomosis, may be responsible for anastomotic recurrence of colon cancer. We aimed to assess the impact of surgical bowel occlusion around the tumor and intraluminal lavage on the presence of exfoliated malignant cells at anastomosis sites in patients with colon cancer.
  
  
  METHODS
  In this prospective study, 32 patients with colon cancer, requiring right hemicolectomy between January 2007 and September 2008, were randomly assigned to a control group (no surgical bowel occlusion; 18 patients) and a "no-touch" group that underwent surgical bowel occlusion around the tumor before tumor manipulation (14 patients). The fluid used intraoperatively to irrigate the portion of the bowel clamped distal to the tumor was examined cytologically, and exfoliated cells of cytological classes IV and V were considered malignant.
  
  
  RESULTS
  In the control group, 2 (11.1%) and 10 (55.6%) of 18 patients had exfoliated malignant cells at the terminal ileum and distal colon anastomosis sites, respectively; however, only 1 (7.1%) of the 14 patients in the no-touch group had exfoliated malignant cells at both the sites. The frequency of exfoliated malignant cells at the distal colon anastomosis site was significantly lower in the no-touch group (p = 0.0024). No exfoliated malignant cells were found upon saline irrigation of 400 ml or more in either group.
  
  
  CONCLUSIONS
  Measures, such as surgical bowel occlusion around the tumor and intraluminal lavage, can prevent or eliminate exfoliated malignant cells at anastomotic sites in patients with colon cancer.
authors.affiliation: Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone, Kita-ku, Sakai, Osaka, 591-8025, Japan. j-hasegawa@orh.go.jp
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Youichirou
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Iwase
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kawano
authors.forename: Riichiro
authors.initials: R
authors.lastname: Nezu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D003110:Colonic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology* / Q000601:surgery