Abstract
Background
Liver resection is the only potential cure for patients with colorectal liver metastasis. However, more than 30% of patients will develop tumour recurrence, probably caused by tumour cells disseminated before or during surgery. As prevention of cell dissemination is barely obtainable, alternative concepts have to be discussed.
Methods
The potential of leukocyte adhesion filters for the removal of cytokeratin positive cells (CK+) from blood was studied in 18 patients undergoing liver resection for colorectal liver metastasis. Blood sampling was done via a liver venous catheter during hepatic mobilisation. Filtration was done with an in-line WBF2 filter system. To define the relation between surgery and cell release we compared patients’ pre-operative and intra-operative blood and bone marrow (BM) samples with their CK expression using immunochemical staining.
Results
CK+ cells were detected in BM samples of nine of 14 patients before surgery, indicating early dissemination. In ten of 18 patients CK+ cells were detected in blood samples during hepatic mobilisation; all ten patients underwent major liver surgery (R0 resection). In those patients recurrent disease was observed more often (P≤0.05). In 17 of 18 patients CK+ cells were not detectable after filtration procedure, which indicated cell adhesion to the filter medium.
Conclusion
Liver resection due to metastasis leads to frequent intra-operative tumour cell shedding. As the detection of CK+ cells is correlated with disease recurrence, modification of surgical techniques to prevent cell dissemination, and additional therapeutic concepts such as advanced filtration technology, have to be discussed.
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Acknowledgements
This work was supported by Deutsche Krebshilfe (project 70-2567-OL2). The authors thank Dr. Markus Neuhäuser (Institute of Medical Mathematics, Biometry and Epidemiology of the University of Essen) for supporting the statistical analyses.
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Frühauf, N.R., Kasimir-Bauer, S., Görlinger, K. et al. Peri-operative filtration of disseminated cytokeratin positive cells in patients with colorectal liver metastasis. Langenbecks Arch Surg 390, 15–20 (2005). https://doi.org/10.1007/s00423-004-0518-3
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DOI: https://doi.org/10.1007/s00423-004-0518-3