OBJECTIVETo evaluate the effect of surgical manipulation on the dissemination of cancer cells into blood circulation in patients with gastric cancer and to analyze its risk factors.

METHODSThis study included 45 consecutive patients with gastric cancer undergoing curative resection and 13 control cases (10 healthy persons and 3 patients with peptic ulcer receiving gastrectomy). Peripheral blood was obtained preoperatively and just after surgical manipulation. The mRNA levels of carcinoembryonic antigen (CEA) from the blood samples were assayed by reverse transcription-polymerase chain reaction(RT-PCR) and compared between the 2 groups.

RESULTSCEA mRNA was negative in all control cases. Of the 45 gastric cancer patients, the preoperative positive rate of CEA mRNA was 8.9%, while the postoperative positive rate was 48.9%, which was significantly higher than that of preoperation (P=0.000). Multivariable Logistic regression analysis showed that operative duration (P=0.014) and tumor depth (P=0.010) were independent risk factors for cancer cell dissemination. Furthermore, the operative duration in patients with positive postoperative CEA mRNA was markedly longer than that in patients with negative postoperative CEA mRNA (P=0.000), and positive rate of postoperative CEA mRNA in advanced gastric cancer was higher compared with that in early gastric cancer (P=0.034).

CONCLUSIONSSurgical manipulation of curative gastrectomy can provoke dissemination of cancer cells into blood circulation, and the operative duration and tumor invasion depth may be 2 of the risk factors for cancer cell dissemination.