Efficacy of Stump Irrigation in Removing Tumor Cells During Low Anterior Resection Using the Double Stapling Technique.
- Author:
Sang Jun PARK
1
;
Hee Cheol KIM
;
Yuen Sik YU
;
Jang Hak YU
;
Chang Sik YU
;
Jin Cheon KIM
Author Information
1. Department of Surgery, University of Ulsan College of Medicine and Colorectal Clinic, Asan Medical Center, Seoul, Korea. hckim@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Surgical stapling;
Irrigation;
Rectal neoplasms/ surgery;
Exfoliated tumor cells;
Neoplasm recurrence;
Local
- MeSH:
Anal Canal;
Classification;
Humans;
Lymph Nodes;
Prospective Studies;
Rectal Neoplasms;
Recurrence;
Surgical Stapling
- From:Journal of the Korean Society of Coloproctology
2004;20(1):52-56
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: In low rectal cancer, creating a permanent stoma can be avoided by applying a low anterior resection using the double stapling technique. However, the problem of local recurrence is still a major pattern of tumor recurrence in rectal cancer. We aimed to verify the clinicopathologic variables related to exfoliation of tumor cells and searched for an efficient method to remove the tumor cells from the rectal stump during a low anterior resection. METHODS: Forty-four patients who underwent a low anterior resection using the double stapling technique were enrolled prospectively. For patient, we irrigated each rectal stump twice with 500 cc of normal saline through the anus. Two specimens from each irrigation were obtained and examined for any malignant tumor cells. Cases in which no tumor cells were found from the two specimens were defined as Group I, cases in which tumor cells were found in only the first specimen were defined as Group II, and cases in which tumor cells were found in both the first and the second specimens were defined as Group III. Clinicopathologic variables were analyzed with regard to the presence of exfoliated tumor cells in irrigated saline. RESULTS: There were sixteen (36%), fourteen (32%), and fourteen cases (32%) in Groups I, II, and III, respectively, according to the examination results. Age classification (P=0.05) and metastatic lymph nodes (P=0.013) were associated with the presence of tumor cells in irrigated saline (I vs. II, II). CONCLUSIONS: Stump irrigation during a low anterior resection using the double stapling technique is recommended as an easy and simple method to remove exfoliated tumor cells from anastomosis sites, although further study is necessary to elucidate the association between exfoliated tumor cells and local recurrence.
