Clinical Investigation Of Implantation Metastasis After Laparoscopic Gastric Resection

Objective:Gastric cancer has ranked 1st of the death causes in the world in the 20th century and has been one of the commonest malignancies in China. In recent years, the minimally invasive surgery represented by endoscopic surgery has expanded its application to various departments and laparoscope has been widely used in various fields of surgery gradually for its irreplacable minimally invasive features. However, since the incision cancer implantation after laparoscopic gastrectomy for gastric cancer has been reported in 1993, persons has gradually realized that laparoscopic gastrectomy for gastric cancer may increase the probability of abdominal implantation metastasis and incision metastasis. This article will compare the effects of laparoscopic gastrectomy and open gastrectomy for gastric cancer on cancer cells' abdominal implantatin metastasis by collecting peritoneal washings, laparoscopic instruments washings before and after the surgery and gas filtration washings. This will provide theoretical evidence for the safety and wide development of laparoscopic gastrectomy for gastric cancer.Methods:120 patients with gastric cancer are included in this study and they are divided into laparoscopic gastrectomy group and open gastrectomy group. Patients in both groups are given laparoscopic gastrectomy and open gastrectomy for gastric cancer respectively.150 ml peritoneal washings are collected before and after the surgery to carry on abdominal exfoliative cancer cytology detection. In the laparoscopic gastrectomy group, CO2 gas is drawed by side holes of trocar after pneumoperitoneum and it will be filtrated by 150ml normal saline, then the filtration will be collected to carry on cancer cytology detection. Apply 150ml normal saline to wash laparoscopic instruments and regular open gastrectomy instruments after the surgery, and then the washings will be given cancer cytology detection. Precipitation will be collected after the centrifugation and will be given HE staining and fixed. Observe the cancer cells under the optical microscope.Results:No cancer cells was found in the CO2 gas filtration of laparoscopic pneumoperitoneum; the laparoscopic instruments washings of 4 cases were positive (6.7%); the instrument washings of 12 cases in open gastrectomy group were positive (20.0%); the positive rates of cancer cells in laparoscopic gastrectomy group and open gastrectomy group are 73.3% and 70.0% respectively while the positive rates of cancer cells after the surgery are 36.7% and 60.0% respectively. The positive cases of cancer cells in peritoneal washings in both of laparoscopic gastrectomy group and open gastrectomy group have decreased comparing with those before the surgery; the positive proportion of cancer cells in peritoneal wahings is associated with TNM classification of gastric cancer, that is to say, the positive rate is higher when the pathological classification is later. Conclusions:The classification of cancer is positively associated with the abdominal implantation which suggests one of the reasons for poor prognosis of cancer. The "stack effect" may not cause the pollution of cancer cells on the incision. The pollution of cancer cells on surgery instruments are one of the main reasons for incision metastasis while the situation in open gastrectomy group is more servere than that in laparoscopic gastrectomy group. Comparing with open gastrectomy, laparoscopic gastrectomy for gastric cancer may reduce the probability of cancer cells implantation to the lowest. Therefore laparoscopic gastrectomy for gastric cancer is safe and reserved further development and research.