| Laparoscopic approach has been widely used in the diagnoses and treatment of various surgical diseases, including in the curative resection of malignancies, due to less lesion, reduced post-operative pain, fewer postoperative complications, and shorter hospitalization of laparoscopic patients than that of open surgery. But, it has been found that the rates of the port-site metastases and intraperitoneal dissemination were higher than that of open surgery after the short time clinical investigation of the use of minimally invasive surgery in setting of cancer. To explain those problems, extremely efforts have been made in recent years. It is suggested that the possible mechanisms for tumor recurrence include the influence of CO2 pneumoperitoneum, tissue trauma at trocar sites and leakage of CO2 along trocar sites, aerosolization of tumor cells, the choose of the type of gases, and the influence of immune function concerning cell- mediated immune function. Up to now, the results of influence of laparoscopic resection of malignancies on tumor growth and recurrence remain discrepancy. To study of laparoscopic resection of malignancies on tumor recurrence and analyze related factors, we designed the following experiments of detecting disseminated tumor cells in the peripheral blood and analyzing the quantitative changes of tumor cells. Objective: Our purpose was to investigate the influence of cancer cells metastase in blood after laparoscopic resection of colorectal cancer and analyse possible relative factors. Methods: From September 2002 to March 2004, 48 patients with primary colorectal cancer were operated on at our hospital. All of patients are divided into laparoscopic approach group (25 cases) and conventional open approach group (23 cases). The peripheral blood samples were obtained from the two groups patients at the day before operation and the first day after operation. Then completed RT-PCR experiment which is based on the peripheral blood samples. Results: In all 48 patients, 35 postive results were got, the postive rate is 72.92%; in laparoscopic approach group 20 postive results were got, the postive rate is 80%; in conventional open approach group 15 postive results were got, the postive rate is 65.22%. Results showed that the quantity of tumor cells in peripheral blood after treatment was remarkably higher than that before operation (P<0.001), and the increase of laparoscopic approach group was obviously higher than that of conventional open approach group (P<0.05). In laparoscopic approach group the results showed that the increase does not have remarkable difference in patients' age (P>0.05), but had remarkable relation with grading of tumor (P<0.05), clinic staging of tumor (P<0.05) and PCNA (P<0.05). Conclutions: The laparoscopic approach can increase the risk of tumor recurrence after treatment, and it is remarkably related with grading of tumor, clinic staging of tumor and PCNA. If the patients receiving laparoscopic colorectal resection of cancer with better grading of tumor, higher clinical staging, and lower PCNA percentage conditon might reduce the risk of blood dissemination of cancer cells.
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