title: Increase in peritoneal recurrence induced by intraoperative hemorrhage in gastrectomy.
abstract: BACKGROUND
  The association between intraoperative hemorrhage and the type of recurrence was examined, with a focus on peritoneal metastasis.
  
  
  METHODS
  A total of 540 patients who underwent macroscopically curative gastrectomy for advanced gastric cancers were reviewed for various clinicopathological characteristics, such as the amount of intraoperative hemorrhage and the pattern of recurrence. Additionally, adhesion assays using gastric cancer cells and mesothelial cells were performed in the presence of blood plasma to assess its effects on cell adhesion.
  
  
  RESULTS
  Large intraoperative hemorrhages were correlated with a higher risk of peritoneal metastasis, while small hemorrhages were not. However, there were no significant differences in the incidence of all recurrences or other types of recurrence between both groups. Multivariate analysis of all cases (T2-4) revealed that large intraoperative hemorrhages were not an independent risk factor for peritoneal recurrence (p = 0.144); however, the large hemorrhage group developed peritoneal recurrence more frequently than the small hemorrhage group in each T stage. In the adhesion assay, the ability of cancer cells and mesothelial cells to adhere to each other was enhanced by the addition of plasma to the culture medium. The addition of heparin significantly decreased the plasma-induced enhancement of cell adhesion of Kato III, but not MKN45 or MKN74.
  
  
  CONCLUSIONS
  Advanced gastric cancer patients accompanied by a large amount of intraoperative hemorrhage are more likely to develop peritoneal recurrence, and this risk might be due, at least in part, to the increased ability of cancer cells and mesothelial cells to adhere to each other.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Arita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hiramoto
authors.forename: Junichi
authors.initials: J
authors.lastname: Hamada
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Shoda
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Shoji
authors.initials: S
authors.lastname: Hirajima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D016022:Case-Control Studies; D002448:Cell Adhesion; D002478:Cells, Cultured; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000556:secondary; D011379:Prognosis; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery