title: Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer.
abstract: Circulating tumor cells (CTCs) disseminate from the primary tumor and travel through the bloodstream and lymphatic system. The detection of and/or increase in the number of CTCs during a patient’s clinical course may be a harbinger of forthcoming overt metastasis. We aimed to examine the impact of 2 different surgical techniques, standard (ST) pancreaticoduodenectomy (PD) and no-touch isolation (NT) PD, on tumor behavior and outcome in patients with pancreatic cancer by using CTCs as biomarkers. In this pilot study, patients were randomized to either ST-PD (n = 6) or NT-PD (n = 6). Intraoperatively, blood samples were taken from the portal vein for measurement of CTCs before and immediately after removal of the tumor. An increase in CTCs was seen in 5 of 6 patients (83%) with ST-PD but no patients with NT-PD (P = .003). In the ST-PD and NT-PD groups, median overall survival was 13.0 and 16.7 months, respectively (P = .33); there was no difference in disease-free survival (P = .42). The use of NT-PD significantly reduced the number of CTCs in the portal vein with no benefit in survival outcomes compared with ST-PD, although more extensive studies are required.
authors.forename: Tamara M H
authors.initials: TM
authors.lastname: Gall
authors.forename: Jimmy
authors.initials: J
authors.lastname: Jacob
authors.forename: Adam E
authors.initials: AE
authors.lastname: Frampton
authors.forename: Jonathan
authors.initials: J
authors.lastname: Krell
authors.forename: Charis
authors.initials: C
authors.lastname: Kyriakides
authors.forename: Leandro
authors.initials: L
authors.lastname: Castellano
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Long R
authors.initials: LR
authors.lastname: Jiao
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D002452:Cell Count; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000517:prevention & control / Q000556:secondary; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000517:prevention & control / Q000556:secondary; D008207:Lymphatic Metastasis / Q000473:pathology* / Q000517:prevention & control*; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*