Comparison Of Circulating Tumor Cells Between Laparoscopic And Laparotomy Of Colorectal Cancer

ObjectiveThe carcinoembryonic antigen messenger RNA(CEA m RNA)of colorectal cancer blood mononuclear cells(BMCs)was monitored to compare the level of circulating tumor cells(CTCs)undergoing colorectal cancer laparoscopic and laparotomy.The effect of the two types of surgical technique on micrometastasis was described and the association between CTCs and clinicopathological characteristics was analyzed to provide more clinical evidence for laparoscopic technology.MethodsDetection of CEA mRNA in BMCs reflect the level of CTCs indirectly.The study included thirty healthy volunteers and sixty colorectal cancer patients,the latter were divided into laparoscopic-group and laparotomy-group randomly.The peripheral venous blood(PB)was taken in each case before and after surgery,the inferior mesenteric venous blood(IMB)taken when the inferior mesenteric venous(IMV)ligated,the IMB taken from specimen when the tumor specimen removed,and the PB taken from healthy volunteers.CEA m RNA in BMCs were detected using Real-time quantitative PCR(q RT-PCR).Data regarding clinical of the sixty colorectal cancer patients were collected.Results1.There were thirteen(21.67%)colorectal cancer patients were detected CEA m RNA in BMCs positive in the PB before surgery of,however,it was not detected in the PB of all healthy volunteers.2.One-way analysis of variance show that the CTCs positivity in relationship to tumor size,differentiation degree,infiltration depth,lymph node involvement,TNM stage and vascular invasion(P>0.05).There was no significant correlation with age,sex,tumor location,gross type and pathological(P>0.05).Multiple logistic regression analysis show that lymph node involvement and vascular invasion are the main risk factors that influence the CTCs diffusion.3.The positive rate of BMCs CEA m RNA in IMB were 35.00% when the IMV ligated,slightly higher than 21.67% of preoperative PB(P=0.11).It was 51.67% in the IMB when the specimen removed,significantly higher than 35.00% in the IMB when IMV was ligated(P=0.01).It was 46.34% in the PB before surgery,slightly higher than 21.67% in the PB after surgery(P=0.71).4.There were seven patients detected CEA m RNA in BMCs positive in the PB before surgery in the laparoscopic-group,the average ?CT of CEA m RNA amplification in the blood(the PB before surgery,the IMB when IMV ligated,the IMB when the specimen removed and the PB after surgery)were 4.59±0.80,3.35±0.34,1.11±0.31,3.69±0.30 respectively.Six patients in the laparotomy-group were 5.10±0.86,2.97±0.36,0.93±0.64,3.31±0.23 respectively.There was no statistical difference in the same venous and period between the two groups(P>0.05).Conclusions1.The level of CEA m RNA in peripheral BMCs indirectly reflect CTCs level.2.The high level of CTCs in colorectal cancer patients is associate with larger tumor size,lower pathological differentiation,deeper local infiltration,later clinical staging,more lymph node involvement and vascular invasion,and they have high risk of micrometastasis.Lymph node involvement and vascular invasion are the main risk factors for micrometastasis.3.Tumor cells diffuse into the circulation through drainage veins undergoing the operation,increase the risk of micrometastasis.4.Tumor cells diffuse into the circulation when the tumor specimen was squeezed both laparoscopic and laparotomy.However,laparoscopic does not increase the risk of micrometastasis.Laparoscopic is as safe and effective as laparotomy.5.Surgical manipulation was the main influence factor on the dissemination of CTCs during operations,but not the type of surgical technique.There could reduce the risk of micrometastasis adherence to the "No touch technique" strictly during surgical operation.