This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Marutsuka, T. Articles by Ogawa, M. Search for Related Content PubMed PubMed Citation Articles by Marutsuka, T. Articles by Ogawa, M.

Mechanisms of Peritoneal Metastasis after Operation for Non-Serosa-invasive Gastric Carcinoma

An Ultrarapid Detection System for Intraperitoneal Free Cancer Cells and a Prophylactic Strategy for Peritoneal Metastasis

Department of Surgery II, Kumamoto University School of Medicine, Kumamoto 860-8556, Japan [T. M., S. S., K. S., N. H., M. O.]; Department of Surgery, Yatsushiro Health Insurance General Hospital, Kumamoto 866-8660, Japan [S. S.]; Department of Surgery, Kumamoto Regional Hospital, Kumamoto 860-0811, Japan [Y. Y.]; and Department of Surgery, Kumamoto Red Cross Hospital, Kumamoto 862-0939, Japan [T. Y.]

Purpose: This aims of this study are to establish an ultra-rapid quantitative reverse transcription-PCR (RT-PCR) protocol that enables the diagnosis of i.p. cancer spread during operation, to reveal the mechanisms of peritoneal metastasis from non-serosa-invasive gastric carcinoma, and to evaluate the effect of the extensive intraoperative peritoneal lavage (EIPL) using the ultra-rapid quantitative RT-PCR as a prophylactic strategy for peritoneal metastasis.

Experimental Design: Peritoneal lavage samples from 63 patients with non-serosa-invasive gastric carcinoma were obtained at laparotomy and immediately after lymph node dissection. To identify the free cancer cells in the samples, carcinoembryonic antigen- and cytokeratin 20-specific RT-PCRs were performed using the LightCycler method in combination with an automated mRNA extractor. In addition, EIPL was performed in five cases with serosa-invasive gastric carcinoma, and its efficacy was evaluated by the ultra-rapid quantitative RT-PCR protocol.

Results: The method enabled us to complete the detection of cancer cells within approximately 70 min. Both the carcinoembryonic antigen and cytokeratin 20 mRNA in i.p. lavages after lymph node dissection were identified in three (14.3%), four (26.7%), and six (46.2%) patients with submucosal, muscularis propria, and subserosal tumors, respectively. Lymph node metastasis was the independent predictor of the existence of i.p. free cancer cells. The ultra-rapid quantitative RT-PCR demonstrated that EIPL reduced free cancer cells from 3.8 x 10⁵ ± 1.4 x 10⁵ cells to 2.8 ± 1.5 cells/100 ml lavage after six to eight washes, and they disappeared after seventh to ninth wash.

Conclusions: The present study proved that lymph node dissection opened lymphatic channels and spread viable cancer cells into the peritoneal cavity. It is suggested that the combination of the novel detection system with the intraoperative therapy of EIPL can be a useful prophylactic strategy for peritoneal metastasis from gastric carcinoma.

This article has been cited by other articles:

				D. Bentrem, A. Wilton, M. Mazumdar, M. Brennan, and D. Coit The Value of Peritoneal Cytology as a Preoperative Predictor in Patients With Gastric Carcinoma Undergoing a Curative Resection Ann. Surg. Oncol., May 1, 2005; 12(5): 347 - 353. [Abstract] [Full Text] [PDF]

				N R Lemoine and I A McNeish Gene transfer: Bax to the future for cancer therapy Gut, April 1, 2004; 53(4): 478 - 479. [Full Text] [PDF]