The presence of carcinoma cells in the suture line may result in local recurrence. The purpose of this study was to assess whether carcinoma cells were present along the resection line where the distal clamp was applied.
Methods
During surgery, the rectum was clamped at least 3 cm distal to the palpable margin of the tumor mass. The rectum was divided distal and proximal to the clamp. The tissue inside the clamp was rinsed with normal saline, and the irrigation solution was sent for cytologic examination.
Results
In 134 patients with carcinoma of the rectosigmoid colon or rectum, we found four (3.0%) cases of positive cytology, and five cases (3.7%) with cytology indicting the presence of atypical cells highly suspicious for malignancy. It was postulated that the trapping of cancer cells in a double-staple anastomosis line may have resulted in local recurrence.
Conclusion
This study indicates that double staple-line recurrence is related to the shedding of cancer cells during dissection and clamping.
