title: Intraluminal exfoliated cancer cells and effectiveness of bowel ligatures during sigmoidectomy for sigmoid colon cancer.
abstract: OBJECTIVE
  To establish the efficiency of bowel ligatures in colon cancer surgery, focusing on the extent to which exfoliated cancer cells are shed in the colonic lumen during sigmoidectomy.
  
  
  METHODS
  Twenty consecutive patients who underwent sigmoidectomy for sigmoid colon cancer were prospectively randomized into two groups: the "ligatures group", in which bowel ligatures were placed, 3, 5, 10 cm from the tumor proximally and distally before dissection; and the "no ligatures group", in which the corresponding sites were ligated only immediately before taking the specimen out. Each colonic segment ligated was irrigated with saline and samples were sent for blind cytological examination.
  
  
  RESULTS
  Cancer cells were found in the colonic segment where the tumor was located, in 18 of 20 samples. The frequency of free cancer cells decreased from 50 to 0 % (p < 0.04) in the distal 3-5 cm colonic segment and from 80 to 20 % (p < 0.03) in the proximal colonic segment after performing bowel ligatures. Free cancer cells were confirmed in 1 of 10 samples at both colonic segments 5-10 cm from the tumor, even after bowel ligatures.
  
  
  CONCLUSIONS
  Intraluminal exfoliated cancer cells could be eliminated by placing bowel ligatures during sigmoidectomy. Measures should be considered to eliminate exfoliated cancer cells during colectomy, even after placing bowel ligatures.
authors: Department of Surgery, Fujita Health University School of Medicine, 1-98 Kutsukake, Toyoake, Aichi, 470-1192, Japan, kmaeda@fujita-hu.ac.jp.
authors: Kotaro
authors: K
authors: Maeda
authors: Tsunekazu
authors: T
authors: Hanai
authors: Harunobu
authors: H
authors: Sato
authors: Koji
authors: K
authors: Masumori
authors: Yoshikazu
authors: Y
authors: Koide
authors: Hiroshi
authors: H
authors: Matsuoka
authors: Hidetoshi
authors: H
authors: Katsuno
authors: Makoto
authors: M
authors: Kuroda
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000473:pathology*; D012809:Colon, Sigmoid / Q000601:surgery*; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009366:Neoplasm Seeding; D011446:Prospective Studies; D012811:Sigmoid Neoplasms / Q000473:pathology* / Q000601:surgery*; D013537:Sutures / Q000009:adverse effects