Correlation between laparoscopic radical resection and tumor markers in peritoneal irrigation fluid.

Abstract

Background: Gastric cancer (GC) is one of the most common malignancies and types of cancer worldwide.

Aim: To compare the differences in tumor markers of GC with GC dissection, we evaluated the efficacy of recent tumor removal.

Methods: A prospective cohort study was conducted to analyze the clinical data of patients with GC. Patients were divided into two groups based on the surgical approach: The membrane dissection (MD) group, which underwent membrane-guided laparoscopic radical gastrectomy with D2 lymph node dissection plus complete mesocolic excision, and the D2 group, which underwent traditional laparoscopic radical gastrectomy with D2 lymph node dissection. Abdominal lavage fluid was collected pre- and postoperatively from patients in both groups. The expression of carcinoembryonic antigen (CEA) and cytokeratin-19 (CK-19) message RNAs in the abdominal lavage fluid was detected using reverse transcription polymerase chain reaction. The factors influencing the increase of the tumor markers were analyzed, and the short-term efficacy of the two surgery types was compared.

Results: In total, 135 eligible patients were included in this study, with 69 and 66 cases in the MD and D2 groups, respectively. Fourteen patients with benign gastric lesions were selected to detect tumor marker expression. After excluding patients positive for preoperative cancer leakage, we found that 9.52% and 26.67% of patients in the MD and D2 groups developed postoperative CEA positivity, respectively. Multivariate analysis revealed that the degree of differentiation and surgical approach were independent risk factors for postoperative CEA positivity. The surgical approach was an independent risk factor affecting postoperative CK-19 positivity and postoperative CEA and CK-19 positivity. Surgical time, intraoperative blood loss, number of lymph nodes dissected, time to first postoperative flatus, and time to first liquid intake were all significantly different between the two surgical approaches. There were no significant differences in the incision length, duration of postoperative hospital stays, or postoperative complications.

Conclusion: MD is a better radical surgical treatment than traditional D2 surgery and is worthy of further clinical promotion and application.