Multivariate Statistical Analysis: Significant Factors Causing Free Malignant Cells in Rectum During Radical Resection of Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZONG Hua , PAN Kai , XIA Ligang , CHEN Xiaochun , ZHONG Keli , LI Mingwei , LIN Liewen , ZHU Chang.

Department of Gastrointestinal Surgery， Shenzhen People’s Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen 518020, ChinaCorresponding Author: ZONG Hua, E-mail: peter_ziliao@163.com;

Corresponding author：

Keywords：

Radical resection of rectal cancer; Rectal washout; Exfoliated malignant cell

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Objective　 To analyze the risk factors inducing tumor cells exfoliating during radical resection of rectal cancer.
Methods 　Sixty patients who were diagnosed as rectal cancer from May 2006 to November 2007 and given radical operations were assigned prospectively in this study. Before cutting the rectal stump below the tumor, saline was instilled into rectum to irrigate the stump. Collected irrigating fluids were sent to pathology laboratory, and the exfoliated malignant cells were tested by HE （haematoxylin and eosin） dyeing and common smear technique. The results of examines were collected and statistical analysis, including a Logistic regression model, was performed.
Results 　Exfoliated malignant cells were found in 27 samples. By univariate analysis, the statistically significant factors defining a high risk of exfoliating were age, tumor size, TNM stage, operation time and operation method (P lt;0.05). Only TNM stage， operation time and operation method were confirmed by Logistic regression analysis to independently result in a statistically significant increased risk of exfoliating.
Conclusion 　Irrigating the rectal stump before cutting down the tumor is essential to avoid local recurrence. The effects of TNM stage, tumor size and operation time are important. Although the laparoscopic surgery is more predominant than conventional surgery for non-neoplasma technology, irrigating is an important process.

Citation： ZONG Hua,PAN Kai,XIA Ligang,CHEN Xiaochun,ZHONG Keli,LI Mingwei,LIN Liewen,ZHU Chang.. Multivariate Statistical Analysis: Significant Factors Causing Free Malignant Cells in Rectum During Radical Resection of Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(4): 304-307. doi: Copy

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1. [1０]Frederick L, David L, Irvin D, et al Eds. AJCC Cancer Staging Handbook [M]. 6th Ed. New York: Springer, 2002: 60.
2. [1３]Gofuku J, Shiozaki H, Tsujinaka T, et al. Expression of E-cadherin and alpha-catenin in patients with colorectal carcinoma. Correlation with cancer invasion and metastasis [Ｊ]. Am J Clin Pathol, 1999; 111(1): 29-37.
3. [1４]戴冬秋, 陈俊青, 徐惠绵, 等. E-钙黏附素及α-链接素的表达与胃癌生物学行为及淋巴结转移规律的关系 [Ｊ]. 中华肿瘤杂志, 2001; 23(1): 35-38.
4. [1５]谷化平, 尚培中. 3种黏附分子表达与老年胃癌临床病理特征和预后的关系 [Ｊ]. 现代肿瘤医学, 2007; 15(11): 1638-1640.
5. [1６]Naito A, Iwase H, Kuzushima T, et al. Clinical significance of Ecadherin expression in thyroid neoplasms [Ｊ]. J Surg Oncol, 2001; 76(3): 176-180.
6. [1７]Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of “rectal washout” [Ｊ]. Dis Colon Rectum, 2004; 47(10): 1706-1710.
7. [1８]Sayfan J, Averbuch F, Koltun L, et al. Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer [Ｊ]. Dis Colon Rectum, 2000; 43(12): 1710-1712.
8. Heimann TM, Szporn A, Bolnick K, et al. Local recurrence following surgical treatment of rectal cancer. Comparison of anterior and abdominoperineal resection [Ｊ]. Dis Colon Rectum, 1986;　29(12): 862-864.
9. Michelassi F, Vannucci L, Ayala JJ, et al. Local recurrence after curative resection of colorectal adenocarcinoma [Ｊ]. Surgery, 1990; 108(4): 787-792.[３] 刘力波, 高丽华, 李宽明, 等. 灌注化疗栓塞后手术切除直肠癌31例报告 [Ｊ]. 中国普外基础与临床杂志, 2005; 12(5): 512-513.[４] 杨枫, 张抒, 于澜, 等. 腹腔镜超声刀联合应用下直肠癌全直肠系膜切除术 [Ｊ]. 中国普外基础与临床杂志, 2001; 8(3): 154-155.[５] Umpleby HC, Fermor B, Symes MO, et al. Viability of exfoliated colorectal carcinoma cells [Ｊ]. Br J Surg, 1984; 71(9): 659-663. [６] Gerster AG. Ⅱ. On the Surgical Dissemination of Cancer [Ｊ]. Ann Surg, 1885; 2(8): 98-109.[７] McGrew EA, Laws JF, Cole WH. Free malignant cells in relation to recurrence of carcinoma of the colon [Ｊ]. J Am Med Assoc, 1954; 154(15): 1251-1254.[８] Le Quesne LP, Thompson AD. Implantation recurrence of carcinoma of rectum and colon [Ｊ]. N Engl J Med, 1958; 258(12): 578-582.[９] Killingback M, Wilson E, Hughes ES. Anal metastases from carcinoma of the rectum and colon [Ｊ]. Aust N Z J Surg, 1965; 34: 178-187.
10. Sobin LH, Wittekind CH Eds. TNM classification of malignant tumors [M]. 6th Ed. New York: Wiley-Liss, 2002: 121-122.
11. 李甘地，杨光华. 肿瘤 [A]. 见：李甘地主编. 病理学　[M]. 第1版. 北京：人民卫生出版社, 2001: 118-120.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multivariate Statistical Analysis: Significant Factors Causing Free Malignant Cells in Rectum During Radical Resection of Rectal Cancer

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