Tumour cell dissemination following endoscopic stent insertion

Maruthachalam, Karthik; Lash, Gendie E.; Shenton, BK; Horgan, Alan

doi:10.1002/bjs.5790

Cited by 246 publications

(152 citation statements)

References 13 publications

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“…Although considered at low risk, 10e20% of patients with colorectal cancer stage I and II ultimately will develop recurrent disease. 10,11 It is in this population that prognostic markers may identify a subgroup of patients who are at a higher risk for disease relapse and who may also benefit from adjuvant therapy, especially from antitumoral agents with low systemic toxicity such as monoclonal antibodies, which have also proven to be effective against dormant tumor cells. 6,7 In this regard, there are several studies that have demonstrated that tumor cell detection is clearly related to an early relapse and decreased survival of the respective patients.…”

Section: Prognostic Factors and Management Of Colorectal Cancermentioning

confidence: 99%

Perioperative tumor cell dissemination in patients with primary or metastatic colorectal cancer

Tralhão

Hoti

Serôdio

et al. 2010

European Journal of Surgical Oncology (EJSO)

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Introduction: Although there is general correlation between the TNM stage of colorectal cancer (CRC) and its prognosis, there is often significant variability of tumor behaviour and individual patient outcome, which is unaccounted for by pathologic factors alone. Our aim was to estimate perioperative tumor cell dissemination in patients with primary or CRC liver metastases as a possible factor influencing the outcome. Methods: Forty patients were prospectively enrolled in the study from the year 2007 to 2008. Eighteen patients had histologically proven CRC (50% rectal, 44% colonic, 6% colonic and rectal). Sixteen patients (47%) had CRC liver metastases only. The remaining six patients who underwent colon or liver resection for benign conditions, acted as the control group. All patients with malignant pathologies had R0 resections. Blood samples were taken before the surgical incision (T0), immediately after tumor resection (T1) and at the end of the surgical intervention (T2). Data acquisition was performed using a dual-laser FACSCalibur flow cytometer. Circulating malignant cells were identified as being CD45À/cytokeratinþ. Results: The analysis of patients overall (CRC resection subgroup and hepatectomy subgroup) revealed that there was no statistically significant difference of the tumoral cell count in the blood per million of hematopoietic cells at T0, T1 and T2. Conclusions: This study demonstrates no differences in the detected circulating numbers of tumor cells at different stages of surgical intervention.

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Section: Prognostic Factors and Management Of Colorectal Cancermentioning

confidence: 99%

Perioperative tumor cell dissemination in patients with primary or metastatic colorectal cancer

Tralhão

Hoti

Serôdio

et al. 2010

European Journal of Surgical Oncology (EJSO)

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“…Theoretically, enforced radical dilatation by a stent could not only increase the risk of perforation, but tumor manipulation can result in cancer cell spread into the surrounding lymphatic vessels and peripheral bloodstream (4,21,22). Accordingly, in the present study, it was found that a markedly increased number of v-CTCs detected by a novel method, TelomeScanF35 (13), was found in patients' circulation after completion of endoscopic stent insertion.…”

Section: Discussionmentioning

confidence: 49%

Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

et al. 2017

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Abstract. The placement of a self-expanding metallic stent (SEMS) in obstructive colorectal cancer (OCRC) is acknowledged to be a safe and effective procedure for the relief of obstruction. However, there is concern that shear forces acting on the tumor during stent expansion may release cancer cells into the circulation, resulting in a poor prognosis. The aim of the present study was to determine whether colonic stent insertion increases viable circulating tumor cells (v-CTCs). A telomerase-specific replication-selective adenovirus-expressing GFP (TelomeScanF35) detection system was used to detect v-CTCs in 8 OCRC patients with a SEMS before and after stent insertion and after surgical resection. In 7 patients, a SEMS was inserted as a bridge to surgery (BTS), and in one patient, a SEMS was inserted for palliation. Surgical resection (R0) was performed in 7 patients. Four patients had no v-CTCs before SEMS placement, two of four measurable patients had an increased number of v-CTCs after SEMS placement (1-3 v-CTCs), and one of two patients with increased v-CTCs developed distant lymphatic metastasis despite curative resection. Four patients had v-CTCs (1-19 cells) before SEMS placement, and two of these four patients had an increase in the number of v-CTCs (20-21 cells) after SEMS placement, while one of the four patients died early with distant metastasis. The present study demonstrated that endoscopic stent insertion for OCRC may result in tumor cell dissemination into the peripheral circulation and may induce distant metastases. IntroductionAt the time of the initial diagnosis of colorectal cancer, 8-13% of patients have obstructive symptoms (1,2). The treatment of choice for these patients has traditionally been emergency surgery. However, most studies have found that the morbidity and mortality rates are higher for emergency colorectal surgery than for elective surgery, and a temporary colostomy, which decreases patients' quality of life, is needed in many patients, which, in 10-40% of cases, becomes permanent (3). The purpose of stenting as a bridge to surgery (BTS) is to relieve the acute situation without emergency surgery, allowing elective surgery to be performed and thus improve surgical outcomes, determine the correct tumor stage, detect synchronous lesions, stabilize comorbidities, and carry out laparoscopic surgery. Immediate results in higher surgical risk patients who were stented were better for primary anastomosis, permanent stoma, wound infection, and overall morbidity, resulting in greater benefit. However, stent insertion was recently reported to have a high risk of perforation, re-obstruction, or stent migration (4,5). Moreover, perforations can lead to peritoneal dissemination. Sabbagh et al (6) reported worse overall survival and higher 5-year cancer-specific mortality of left-sided obstructive colorectal cancer (OCRC) patients with self-expanding metallic stent (SEMS) insertion than emergency surgery due to perforation induced by stent insertion. Furthermore, SEMS insertion as a BTS is ...

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“…Early studies suggested an oncological compromise associated with tumour perforation or tumour cell dislodgement during SEMS insertion resulting in seeding of malignant cells. 13 Manipulation of the tumour by the shearing forces of endoscopy and colonic insufflation is thought to disseminate tumour cells locally and into the circulation. 43 Three RCTs have investigated long-term oncological outcome, all the sample sizes were small (15-26 patients in the SEMS groups), and found increased disease recurrence in the SEMS groups.…”

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

“…11 Importantly, in the latter scenario, concern has been raised following analysis of RCT follow-up data regarding the oncological impact of SEMS use. [12][13][14] It is only recently that there has been some clarity as to the most appropriate clinical indications for SEMS in malignant colonic obstruction.…”

Section: Introductionmentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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Tumour cell dissemination following endoscopic stent insertion

Abstract: Endoscopic insertion of colonic stents but not staging colonoscopy results in increased levels of CK20 mRNA in the peripheral circulation.

Cited by 246 publications

References 13 publications

Perioperative tumor cell dissemination in patients with primary or metastatic colorectal cancer

Perioperative tumor cell dissemination in patients with primary or metastatic colorectal cancer

Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

Colonic cancer: The current role of stent insertion

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