title: Positive detection of exfoliated colon cancer cells on linear stapler cartridges was associated with depth of tumor invasion and preoperative bowel preparation in colon cancer.
abstract: BACKGROUND
  The aim of this study was to investigate exfoliated cancer cells (ECCs) on linear stapler cartridges used for anastomotic sites in colon cancer.
  
  
  METHODS
  We prospectively analyzed ECCs on linear stapler cartridges used for anastomosis in 100 colon cancer patients who underwent colectomy. Having completed the functional end-to-end anastomosis, the linear stapler cartridges were irrigated with saline, which was collected for cytological examination and cytological diagnoses were made by board-certified pathologists based on Papanicolaou staining.
  
  
  RESULTS
  The detection rate of ECCs on the linear stapler cartridges was 20 %. Positive detection of ECCs was significantly associated with depth of tumor invasion (p = 0.012) and preoperative bowel preparation (p = 0.003). There were no marked differences between ECC-positive and ECC-negative groups in terms of the operation methods, tumor location, histopathological classification, and surgical margins.
  
  
  CONCLUSIONS
  Since ECCs were identified on the cartridge of the linear stapler used for anastomosis, preoperative mechanical bowel preparation using polyethylene glycol solution and cleansing at anastomotic sites using tumoricidal agents before anastomosis may be necessary to decrease ECCs in advanced colon cancer.
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.
authors: Kishiko
authors: K
authors: Ikehara
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan. endoswing@gmail.com.|Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan. endoswing@gmail.com.
authors: Shungo
authors: S
authors: Endo
authors: Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors: Kensuke
authors: K
authors: Kumamoto
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.
authors: Eiji
authors: E
authors: Hidaka
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.
authors: Fumio
authors: F
authors: Ishida
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.|Department of Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan.
authors: Jun-Ichi
authors: J
authors: Tanaka
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.
authors: Shin-Ei
authors: SE
authors: Kudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000295:instrumentation; D003082:Colectomy / Q000009:adverse effects* / Q000295:instrumentation; D003106:Colon; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D004733:Enema; D005260:Female; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000517:prevention & control; D009367:Neoplasm Staging; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: D054368:Laxatives; D011092:Polyethylene Glycols
keywords: Colon cancer; Exfoliated cancer cell; Functional end-to-end anastomosis; Suture-line recurrence