Examination of Exfoliated Malignant Cells Collected with Intraluminal Lavage in Anterior Resection

Intra-operative Rectal Washout with Saline Solution Can Effectively Prevent Anastomotic Recurrence: a Meta-analysis

“…The pooled OR (0.32) derived from the 5 studies, which is lower than those (0.57~0.64) reported by Constantinides et al (2008), Rondelli et al (2012) and Matsuda et al (2013), indicates that rectal washout significantly reduced the risk of local recurrence of rectal cancer by 68%. These differences may be due to the fact that none of these previous metaanalyses used different types of washout solutions, such as povidone-iodine (Long et al, 1989), cetrimide (Agaba et al, 2004) 0.9% NaCl (Fukuda et al, 1991;Shinto et al, 1996;Kawahara et al, 1998;Nakano et al, 2004) and formalin (Terzi et al, 2006), which had varied effects on cancer cells. The reason for the low overall AR rate may be that most rectal cancer cells are extra-luminal and out of the reach of rectal washout (Agaba et al, 2004).…”

“…For this reason, a thorough mechanical rectal irrigation with normal saline will probably eliminate exfoliated malignant cells and prevent the implantation of these cells and the anastomotic recurrence of rectal cancer (Long et al, 1989;Juhl et al, 1990;Fukuda et al, 1991;Sayfan et al2000;Church et al, 2003;Agaba et al, 2004;Terzi et al, 2006). However, there is no conclusive evidence of a beneficial effect of intraoperative rectal washout on anastomotic recurrence after anterior resection of rectal cancer (Fukuda et al, 1991;Shinto et al, 1996;Kawahara et al, 1998;Nakano et al, 2004).…”