Changes to circulating tumor cells in the central vein during laparoscopic versus transanal endoscopic surgeries for rectal cancer: can surgical approach make a difference?

IF 3.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterology Report Pub Date : 2024-06-26 eCollection Date: 2024-01-01 DOI:10.1093/gastro/goae062

Mian Chen, Fujin Ye, Wenwen Zheng, Li Xiong, Zhenxing Liang, Huashan Liu, Xiaobin Zheng, Wenxin Li, Liang Kang, Liang Huang

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引用次数: 0

Abstract

Background: The oncological safety of transanal total mesorectal excision (taTME) remains uncertain, and its special surgical approach may contribute to tumor cell dissemination. Thus, we conducted a study to investigate the impact of surgical approach on circulating tumor cell (CTC) counts and phenotypes in rectal cancer.

Methods: This is a prospective randomized controlled study (ClinicalTrials: NCT05109130). The patients were randomized to either the taTME (n = 49) or laparoscopic TME (laTME) (n = 48) groups. Blood samples were collected from the central vein to measure CTC counts and phenotypes at three time points: preoperative (t1), immediately post-tumor removal (t2), and one week post-surgery (t3). The effect of surgical procedure on CTCs at each time point was analyzed, with the primary endpoint being the change in CTC counts from t1 to t3 for each surgical approach. This study adheres to Consolidated Standards of Reporting Trials Guidelines.

Results: The baseline clinicopathologic characteristics of the laTME and taTME groups were balanced. The change in CTC count from t1 to t3 was 1.81 ± 5.66 in the laTME group and 2.18 ± 5.53 in the taTME group. The taTME surgery was non-inferior to laTME in terms of changing CTC counts (mean difference [MD]: -0.371; 95% confidence interval [CI]: -2.626 to 1.883, upper-sided 95% CI of 1.883 < 2, non-inferiority boundary value). Compared with that at t1, the CTC count at t2 did not change significantly. However, higher CTC counts were detected at t3 than at t2 in the taTME (P = 0.032) and laTME (P = 0.003) groups. From t1 to t3, CTC counts significantly increased in both the taTME (P = 0.008) and laTME (P = 0.031) groups. There were no significant differences in CTC phenotype changes between the two groups from t1 to t3.

Conclusions: Compared with laTME, taTME did not affect CTC counts and phenotypes. Our findings indicate that taTME is not inferior to laTME in terms of CTC changes from an oncological perspective.

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直肠癌腹腔镜手术与经肛门内镜手术期间中央静脉中循环肿瘤细胞的变化：手术方法会产生影响吗？

背景：经肛门全直肠系膜切除术（taTME）的肿瘤安全性仍不确定，其特殊的手术方式可能会导致肿瘤细胞扩散。因此，我们开展了一项研究，探讨手术方式对直肠癌循环肿瘤细胞（CTC）数量和表型的影响：这是一项前瞻性随机对照研究（ClinicalTrials：NCT05109130）。患者被随机分配到腹腔镜直肠癌切除术（taTME）组（n = 49）或腹腔镜直肠癌切除术（laTME）组（n = 48）。从中央静脉采集血液样本，在三个时间点测量 CTC 计数和表型：术前（t1）、肿瘤切除后立即（t2）和术后一周（t3）。在每个时间点分析手术方法对 CTC 的影响，主要终点是每种手术方法的 CTC 数量从 t1 到 t3 的变化。本研究遵循《试验报告统一标准指南》：结果：laTME组和taTME组的基线临床病理特征均衡。从 t1 到 t3，laTME 组的 CTC 数量变化为 1.81 ± 5.66，taTME 组为 2.18 ± 5.53。在 CTC 计数变化方面，taTME 手术效果不劣于 laTME 组（平均差 [MD]：-0.371；95% 置信区间 [CI]：-2.626 至 1.883，上侧 95% CI 为 1.883，P = 0.032）和 laTME 组（P = 0.003）。从 t1 到 t3，taTME 组（P = 0.008）和 laTME 组（P = 0.031）的 CTC 计数均显著增加。从 t1 到 t3，两组的 CTC 表型变化无明显差异：结论：与 laTME 相比，taTME 不会影响 CTC 的数量和表型。我们的研究结果表明，从肿瘤学角度来看，taTME 在 CTC 变化方面并不逊色于 laTME。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastroenterology Report Medicine-Gastroenterology

CiteScore

4.60

自引率

2.80%

发文量

审稿时长

8 weeks

期刊介绍： Gastroenterology Report is an international fully open access (OA) online only journal, covering all areas related to gastrointestinal sciences, including studies of the alimentary tract, liver, biliary, pancreas, enteral nutrition and related fields. The journal aims to publish high quality research articles on both basic and clinical gastroenterology, authoritative reviews that bring together new advances in the field, as well as commentaries and highlight pieces that provide expert analysis of topical issues.