Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
KF Wong (1), TK Fung (1), SW Yu (1), SL Cheung (1), WF Wong (1), PC Yam (1), CW Yiu (1), HL Yiu (1), SK Leung (1)
Affiliation :
(1) Department of Surgery, Tuen Mun Hospital
Introduction :
Complete tumour excision is the basic principle of curative surgery. However, it is questionable whether surgery itself will cause tumour spillage. Before this study, no clinical data to support this concept.
Objectives :
Investigate (1) the impact of cancer surgery per se upon tumour cells spillage, (2) various potential routes of tumour cells spillage during operations.
We called these spilt tumour cells during operations the Escapee Tumour cells (ET cells).
Methodology :
A prospective cohort study was conducted (1/2019 to 3/2022). 133 tumour-related operations were performed. Routine operating field toileting was performed by using warm normal saline before the end of operations. A filter was connected to the suction device throughout the whole operation. Sediments being trapped by the filter were sent for histopathology to look for the presence of ET cells.
Patients’ demographic data, clinical information, operation details and histopathological findings of tumour and residue samples were reviewed. Univariate and then multi-variable logistic regression model was used to analyze the presence and potential routes of ET cells spread. Type I error adopted was 0.05.
Result & Outcome :
In 133 patients, 26 (19.5%) and 16 (12%) of the collected residue showed the presence of ET cells and atypical cells respectively.
Upon univariate analysis, variables, including sex, age, BMI, residue block taken, volume of residue saved, tumour cells differentiation, neo-adjuvant therapy, extended lymph node dissection, operation time, operating blood loss and presence of lymph-vascular/ peri-neural invasion, no statistically significant difference was detected between ET-positive and ET-negative groups.
Variables deemed associated significantly with ET cell status in univariate analysis were further analyzed by using multi-variable logistic regression model.
Incomplete resection (R1, R2 resection, p-value: 0.005, B-value: 1.519), advanced N-stage (N2 or N3 disease, p-value: 0.031, B-value: 1.510) and certain cancer type (oesophageal cancer in this study, p-value: 0.027, B-value: -1.567) are the statistical significant factors related with the presence of ET cells.
For the first time, this study provides the scientific prove for the presence of ET cells in oncological surgery resection. It also suggests potential routes of ET cells spillage and gives us the insight of the clinical significance of ET cells and prevention of tumour spillage during operations in the future.
