Clinical Significance Of Detection Of Tumor Cells In Abdominal Cavity Before And After Operation In Patients With Colorectal Cancer

ObjectiveTo explore the correlation between tumor gross type,tumor location,patient gender,tumor size,tumor stage,surgical mode,degree of differentiation,and operation time,and the positive rate of abdominal cavity tumor cell detection near surgical specimens of colorectal cancer patients,and the clinical significance of detection,so as to improve the understanding of abdominal cavity tumor cell removal.MethodsFrom March 2018 to November 2018,62 patients with colorectal cancer were selected.These patients had complete case data,and the diagnosis was confirmed by preoperative colonoscopy and pathological examination.None of them received chemotherapy or other treatment before surgery.There were 33 cases of male patients,29 cases of female patients,age 36 to 85 years old,the average age was(60.2±3.2)years,and the median age was 61 years.According to the specific parts of the colorectal in the tumor: 7 cases of descending colon cancer,5 cases of transverse colon cancer,13 cases of ascending colon cancer,12 cases of sigmoid colon cancer,25 cases of rectal cancer.Among them,2 patients had recurrence after rectal cancer operation,1 cases had recurrence of anastomotic mouth after4 years of rectal Dixon operation,1 cases had the recurrence of Anastomotic site 8 years after low rectal anterior resection,considering that recurrent rectal cancer might affect the test results of this study,the 2 patients were kicked out of the experiment,and the experimental specimens were actually included in 60 cases.60 patients were grouped according to different categories,divided according to the degree of differentiation of tumor: 5 cases of high differentiated adenocarcinoma,25 cases of differentiated adenocarcinoma,30 cases of low differentiated adenocarcinoma.According to the general type of tumor: 31 cases of ulcer type,13 cases of mass type,16 cases of infiltration type.According to tumor TNM staging: 11 Cases of stage I tumor,24 cases of phase II tumor,25 cases of phase III tumor.According to the surgical method,42 patients underwent open surgery and 18 underwent laparoscopic surgery.According to the NCCN guidelines,patients underwent chest X-ray,electrocardiogram,pulmonary function,echocardiography,abdominal enhanced CT,abdominal B-ultrasound and blood biochemical examination before surgery.Patients with rectal cancer also need pelvic MRI to confirm that they are eligible.After the standard,individualized treatment plans are developed for them.The clinical significance of detection of peritoneal exfoliated tumor cells before and after operation in patients with colorectal cancer was investigated.Before and after tumor resection,500 ml of normal saline was injected for peritoneal lavage,and the abdominal cavity was treated with distilled water 2000 ml before the abdomen.Irrigation,collection and treatment of lavage fluid,cell smear,HE staining,cell wax block and wax sheet production,microscopic observation,collection of pathological features,tumor location,tumor stage,tumor size,patient gender,operation time According to the data of surgical methods,a single-factor logistic regression model and a multi-factor logistic regression model were established.The factors related to peritoneal exfoliated cancer cells were analyzed by univariate analysis.Multivariate logistic regression analysis was performed on the relevant variables in the univariate analysis.ResultsThe results of unifactorial analysis showed that there was no significant difference in the data of sex,surgical mode,age and tumor location on the exfoliation of abdominal tumor cells in colorectal patients(P > 0.05).The results showed that there was no significant correlation between the sex,surgical mode,age and tumor location of the patients and the positive rate of tumor cells shedding to the abdominal cavity.There were significant differences in tumor size,tumor gross type,tumor TNM stage and differentiation on celiac exfoliation of colorectal tumor cells,which could be used as the main influencing factor of tumor cell exfoliation to abdominal cavity in patients with colorectal cancer.Four factors(TNM stage,tumor size,tumor gross type,tumor differentiation degree)which had statistical significance in the test results of exfoliated tumor cells in celiac lavage fluid of colorectal cancer were further analyzed by multivariate Logistic regression analysis.Multivariate regression analysis showed that the main factors affecting the exfoliation of colorectal cancer tumor cells were tumor size and gross type.Among them,the strongest influencing factor on colorectal cancer cell exfoliation is the gross type of tumor.ConclusionIn colorectal cancer patients,tumor cells exfoliate in the abdominal cavity adjacent to the tumor.The average positive rate of exfoliated cell smear in abdominal lavage fluid before operation was 56.7%,78.6% after tumor resection and 33.3% before abdominal closure.The positive rate of exfoliated cells in abdominal cavity was closely related to TNM stage,tumor size,differentiation degree and gross type.Surgical operation can lead to the increase of the positive rate of exfoliated cells.Patients with colorectal cancer whose abdominal exfoliated tumor cells are positive are treated with abdominal warm distilled water flushing and other effective methods to block or kill free tumor cells.It can reduce the positive rate of exfoliated tumor cells,and provide a good clinical reference significance for guiding the clinical treatment and prognosis of colorectal cancer.