Colorectal cancer metastasis: in the surgeon's hands?
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BioMed Central
Open Access
Review
Colorectal cancer metastasis: in the surgeon's hands? Gary Atkin*1, Abhay Chopada2 and Ian Mitchell1 Address: 1Department of Surgery, Barnet General Hospital, Wellhouse Lane, Herts, EN5 3DJ, UK and 2Department of Surgery, Ealing Hospital, Uxbridge Rd, Middlesex, UB1 3HW, UK Email: Gary Atkin* - [email protected]; Abhay Chopada - [email protected]; Ian Mitchell - [email protected] * Corresponding author
Published: 24 February 2005 International Seminars in Surgical Oncology 2005, 2:5
doi:10.1186/1477-7800-2-5
Received: 18 December 2004 Accepted: 24 February 2005
This article is available from: http://www.issoonline.com/content/2/1/5 © 2005 Atkin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Lymphovascular ligation before tumour manipulation during colorectal cancer resection is termed the 'no-touch isolation' technique. It aims to reduce the intra-operative dissemination of colorectal cancer cells. Recently, the detection of circulating tumour cells has been enhanced by molecular biology techniques. This paper reviews the evidence for the no-touch isolation technique in light of the recent developments in circulating tumour cell detection. Methods: Studies investigating the effect of colorectal cancer surgery on circulating tumour cells were identified by a Medline search using the subject headings colorectal neoplasms and neoplasm circulating cells together with the map term 'no-touch isolation technique'. Further references were obtained from key articles. Results: Molecular biological techniques have improved the detection of circulating colorectal cancer cells. There is a trend towards reduced tumour cell dissemination with the no-touch technique compared with the conventional method. However the benefit in terms of improved patient survival remains unproven. Conclusion: The no-touch isolation technique reduces circulating tumour cell dissemination but further work is needed to determine the significance of this with regards to patient survival.
Background Of the patients with colorectal cancer (CRC) undergoing surgery for resectable disease, 30–50% will subsequently develop metastases [1]. Dissemination of tumour cells is therefore thought to occur early on in the disease process. The principle of early lymphovascular ligation before manipulation of the tumour during the surgical resection of a CRC has been termed the 'no-touch isolation' technique. This was proposed by Barnes [2] as a way of reducing the incidence of liver metastases by diminishing the intra-operative dissemination of CRC cells. An early pro-
ponent of the technique was Turnbull et al [3], but their findings have not been confirmed in other studies [4]. Animal studies suggest tumour cells are
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