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Surgery-Induced Peritoneal Cancer Cells in Patients Who Have Undergone Curative Gastrectomy for Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Some patients who undergo curative gastrectomy with lymph node dissection (LND) for gastric cancer (GC) show subsequent peritoneal metastasis. The source of these metastatic cells remains unclear.

Methods

Curative gastrectomy with LND was performed in 102 patients with GC. Peritoneal washing was collected before and after gastrectomy. Cytology, reverse transcription-polymerase chain reaction, and cell culture were used to determine the presence of cancer cells. The proliferative potential of tumor cells was evaluated using Ki-67 staining. Tumorigenic capacity was assessed by cell injection into the peritoneal cavity of NOD/ShiJic-scid mice. Peritoneal recurrence-free survival (RFS) and peritoneal recurrence rate (RR) were examined to determine the clinical relevance of detected cancer cells.

Results

Of 102 peritoneal washing samples obtained before gastrectomy, 57 showed no CEA or CK20 mRNA amplification. After gastrectomy, CEA or CK20 mRNA was detected in 35 of these 57 samples, and viable cancer cells were identified in 24. The viable cancer cells in all 24 cases showed Ki-67 positivity, indicating proliferative activity. Cultured viable cancer cells generated peritoneal nodules after spilling over the peritoneal cavity in NOD/ShiJic-scid mice in 4 cases. The peritoneal RFS of patients with CEA or CK20 mRNA amplification after gastrectomy was significantly poorer than that of patients with negative amplification (p < .05). The 24 patients with viable cancer cells in the peritoneal cavity after gastrectomy showed higher peritoneal RR than those without them (p = .033).

Conclusions

Viable tumorigenic cancer cells spilled into the peritoneal cavity during surgery, indicating that surgery induces peritoneal metastasis.

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Acknowledgment

We thank Mrs. Ikuko Arikawa, Mrs. Ai Kenmochi, and Mrs. Miho Yamamoto for technical assistance. We thank Dr. Hirohito Ishigaki and Mr. Hideaki Ishida at the Department of Pathology for the valuable discussions.

Disclosure

Katsushi Takebayashi and the other co-authors have no commercial conflicts of interest in the subject of study.

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Authors and Affiliations

  1. Department of Surgery, Shiga University of Medical Science, Otsu, Japan

    Katsushi Takebayashi MD, Satoshi Murata MD, Hiroshi Yamamoto MD, Tsuyoshi Yamaguchi MD, Masatsugu Kojima MD, Tomoharu Shimizu MD, Hisanori Shiomi MD, Hiromichi Sonoda MD, Shigeyuki Naka MD, Eiji Mekata MD & Tohru Tani MD

  2. Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan

    Mitsuaki Ishida PhD, Eiji Mekata MD & Hidetoshi Okabe PhD

Authors
  1. Katsushi Takebayashi MD
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  2. Satoshi Murata MD
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  3. Hiroshi Yamamoto MD
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  4. Mitsuaki Ishida PhD
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  5. Tsuyoshi Yamaguchi MD
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  6. Masatsugu Kojima MD
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  7. Tomoharu Shimizu MD
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  8. Hisanori Shiomi MD
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  9. Hiromichi Sonoda MD
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  10. Shigeyuki Naka MD
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  11. Eiji Mekata MD
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  12. Hidetoshi Okabe PhD
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  13. Tohru Tani MD
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Corresponding author

Correspondence to Satoshi Murata MD.

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Takebayashi, K., Murata, S., Yamamoto, H. et al. Surgery-Induced Peritoneal Cancer Cells in Patients Who Have Undergone Curative Gastrectomy for Gastric Cancer. Ann Surg Oncol 21, 1991–1997 (2014). https://doi.org/10.1245/s10434-014-3525-9

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  • DOI: https://doi.org/10.1245/s10434-014-3525-9

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