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Intraoperative esophageal washout reduces free intraluminal tumor cells during resection of carcinomas of the esophagus and cardia.
Maurer, Christoph Andreas; Walensi, Mikolaj; Mattiello, Diana; Käser, Samuel Andreas; Zarfl, Kathrin; Egger, Christine.
Afiliación
  • Maurer CA; Visceral Surgery, HIRSLANDEN Private Hospital Group, Clinic Beau-Site, Bern, Switzerland; Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland. Electronic address: christoph.maurer@hin.ch.
  • Walensi M; Clinical Trial Unit, HIRSLANDEN Private Hospital Group, Klinik Hirslanden, Zurich, Switzerland; Elisabeth-Hospital Essen, Department of Vascular Surgery and Phlebology Essen, Germany.
  • Mattiello D; Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; Department of Surgery, Spital Limmattal, Schlieren, Switzerland.
  • Käser SA; Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; soH Solothurner Spitäler AG, Department of General, Visceral, Thoracic and Vascular Surgery, Solothurn, Switzerland.
  • Zarfl K; Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; Department of Surgery, Hospital of Dornbirn, Dornbirn, Austria.
  • Egger C; Institute of Pathology Länggasse, Bern, Switzerland.
Eur J Surg Oncol ; 50(4): 108017, 2024 Apr.
Article en En | MEDLINE | ID: mdl-38377885
ABSTRACT

OBJECTIVE:

Intraluminally shed viable tumor cells might contribute to anastomotic recurrence in cancer of the esophagus and the cardia. The study aimed to establish a method of esophageal washout and, hence, to reduce intraluminal cancer cells before esophageal anastomosis.

METHODS:

Forty-eight consecutive patients with esophago-gastric resection for histologically proven cancer of the esophagus or the cardia were included in a prospective, interventional study. Before transection, the esophagus was clamped proximally to the tumor and rinsed with 110 diluted povidone-iodine-solution (10 × 30 ml) applied by a transorally inserted 24F-Foley catheter. The first, fifth and tenth portion of the lavage fluid were sent to cytological examination.

RESULTS:

Intraoperative frozen sections confirmed clear proximal resection margins of the esophagus. The cytological examination of the fluid recovered from the esophageal washout revealed malignant cells in 13/48 patients (27%). The presence of malignant cells was significantly less likely in patients with neoadjuvant treatment than in patients without neoadjuvant treatment 2/23 (9%) vs. 11/25 (44%) (p = 0.009). Repetitive washout reduced the probability of detectable malignant cells from 13 to 8 (62%) patients after 5, and further to 4 patients (30%) after 10 washout maneuvers.

CONCLUSIONS:

Free malignant cells may be present in the esophageal lumen following intraoperative manipulation of cancers of the esophagus or cardia. Transoral washout of the esophagus is novel, feasible and enables reduction or even elimination of these tumor cells. The reliability of this procedure raises with increasing washout volume. Esophageal washout might be especially worthwhile in patients who do not receive neoadjuvant therapy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Gástricas / Neoplasias Esofágicas / Carcinoma Límite: Humans Idioma: En Revista: Eur J Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Gástricas / Neoplasias Esofágicas / Carcinoma Límite: Humans Idioma: En Revista: Eur J Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido