Influence of the Ligation Sequence of the Inferior Mesenteric Artery and Vein on Circulating Tumor Cells in Laparoscopic Rectal Cancer Surgery: a Prospective Pilot Study

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2024 Nov 27

PMID 39593146

Authors

Tao Pan

Chang-Bo Nie

Chao Liu

Hai Hu

Affiliations

Soon will be listed here.

Abstract

Background: There is no regulation in the current guidelines on the sequence of ligation of the inferior mesenteric artery and vein during rectal cancer surgery owing to a lack of sufficient evidence. Circulating tumor cells (CTCs) in peripheral blood can be used as potential indicators for predicting prognosis in colorectal cancer patients. This study aims to explore the feasibility of different ligation sequences for the inferior mesenteric vessels and their potential influence on CTCs.

Methods: This pilot study involved 29 stage I-III rectal adenocarcinoma patients undergoing laparoscopic surgery. Patients were allocated into two groups based on the sequence of vascular ligation: vein-first (V-first) and artery-first (A-first). The primary objective was to assess the impact of the ligation sequence on peripheral blood CTC levels pre- and post-operatively. Secondary outcomes included intraoperative complications, surgical duration, blood loss, and number of lymph nodes harvested, and postoperative complications. The study was approved by the ethics committee of our hospital (SCCHEC-02-2024-102), and all patients provided informed consent.

Results: No significant differences were found between the two groups regarding surgical duration, blood loss, lymph nodes harvested, or postoperative complications. A reduction in CTCs postoperatively was observed in 36% of patients in the V-first group, in comparison to 20% in the A-first group.

Conclusion: Both A-first and V-first ligation sequences are viable and safe options in laparoscopic rectal cancer surgery. The V-first approach may be more effective in reducing levels of CTCs in peripheral blood. Further randomized studies are warranted to explore these findings comprehensively.

References

Sastre J, Maestro M, Gomez-Espana A, Rivera F, Valladares M, Massuti B . Circulating tumor cell count is a prognostic factor in metastatic colorectal cancer patients receiving first-line chemotherapy plus bevacizumab: a Spanish Cooperative Group for the Treatment of Digestive Tumors study. Oncologist. 2012; 17(7):947-55. PMC: 3399651. DOI: 10.1634/theoncologist.2012-0048. View

Takii Y, Mizusawa J, Kanemitsu Y, Komori K, Shiozawa M, Ohue M . The Conventional Technique Versus the No-touch Isolation Technique for Primary Tumor Resection in Patients With Colon Cancer (JCOG1006): A Multicenter, Open-label, Randomized, Phase III Trial. Ann Surg. 2022; 275(5):849-855. DOI: 10.1097/SLA.0000000000005241. View

Wei S, Guo C, He J, Tan Q, Mei J, Yang Z . Effect of Vein-First vs Artery-First Surgical Technique on Circulating Tumor Cells and Survival in Patients With Non-Small Cell Lung Cancer: A Randomized Clinical Trial and Registry-Based Propensity Score Matching Analysis. JAMA Surg. 2019; 154(7):e190972. PMC: 6495366. DOI: 10.1001/jamasurg.2019.0972. View

Sastre J, Maestro M, Puente J, Veganzones S, Alfonso R, Rafael S . Circulating tumor cells in colorectal cancer: correlation with clinical and pathological variables. Ann Oncol. 2008; 19(5):935-8. DOI: 10.1093/annonc/mdm583. View

Weiser M . AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol. 2018; 25(6):1454-1455. DOI: 10.1245/s10434-018-6462-1. View

Green B, Marshall H, Collinson F, Quirke P, Guillou P, Jayne D . Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2012; 100(1):75-82. DOI: 10.1002/bjs.8945. View

Ng S, Leung K, Lee J, Yiu R, Li J, Hon S . Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum. 2009; 52(4):558-66. DOI: 10.1007/DCR.0b013e31819ec20c. View

Maggiori L, Rullier E, Lefevre J, Regimbeau J, Berdah S, Karoui M . Does a Combination of Laparoscopic Approach and Full Fast Track Multimodal Management Decrease Postoperative Morbidity?: A Multicenter Randomized Controlled Trial. Ann Surg. 2017; 266(5):729-737. DOI: 10.1097/SLA.0000000000002394. View

Rhyne R, Rishel Brakey H, Halladay J, Mottus K, Greiner K, Salt E . A non-randomized pilot study to test the feasibility of treating chronic pain and opioid prescription use in rural areas with acceptance and commitment therapy (T-PACT). J Clin Transl Sci. 2020; 4(5):472-476. PMC: 7681117. DOI: 10.1017/cts.2020.26. View

10.

Heald R, Husband E, Ryall R . The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?. Br J Surg. 1982; 69(10):613-6. DOI: 10.1002/bjs.1800691019. View

11.

Liu Z, Gu Y, Yu F, Zhou L, Cheng X, Jiang H . The Number of Intraoperative Intestinal Venous Circulating Tumor Cells Is a Prognostic Factor for Colorectal Cancer Patients. Evid Based Complement Alternat Med. 2022; 2022:4162354. PMC: 9525778. DOI: 10.1155/2022/4162354. View

12.

Allen-Mersh T, McCullough T, Patel H, Wharton R, Glover C, Jonas S . Role of circulating tumour cells in predicting recurrence after excision of primary colorectal carcinoma. Br J Surg. 2006; 94(1):96-105. DOI: 10.1002/bjs.5526. View

13.

Takii Y, Shimada Y, Moriya Y, Nakamura K, Katayama H, Kimura A . A randomized controlled trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colorectal cancer: Japan Clinical Oncology Group Study JCOG1006. Jpn J Clin Oncol. 2013; 44(1):97-100. PMC: 3880145. DOI: 10.1093/jjco/hyt156. View

14.

Kurusu Y, Yamashita J, Hayashi N, Mita S, Fujino N, Ogawa M . The sequence of vessel ligation affects tumor release into the circulation. J Thorac Cardiovasc Surg. 1998; 116(1):107-13. DOI: 10.1016/s0022-5223(98)70248-x. View

15.

Sales J, Wind P, Douard R, Cugnenc P, Loric S . Blood dissemination of colonic epithelial cells during no-touch surgery for rectosigmoid cancer. Lancet. 1999; 354(9176):392. DOI: 10.1016/S0140-6736(99)92164-5. View

16.

Siegel R, Miller K, Wagle N, Jemal A . Cancer statistics, 2023. CA Cancer J Clin. 2023; 73(1):17-48. DOI: 10.3322/caac.21763. View

17.

Lancaster G, Thabane L . Guidelines for reporting non-randomised pilot and feasibility studies. Pilot Feasibility Stud. 2019; 5:114. PMC: 6778655. DOI: 10.1186/s40814-019-0499-1. View