CEA Study on the Effect of the No-touch Isolation Technique for Preventing Tumor Metastasis in Patients with Colorectal Cancer

다국어 초록 (Multilingual Abstract)

Purpose:CEA Study on the Effect of the No-touch Isolation Technique for Preventing Tumor Metastasis in Patients with Colorectal Cancer
Division of Colorectal Surgery, Department of Surgery, 1Immunology and 2Clinical Pathology, School of Medicine,
Keimyung University, Daegu, Korea
Ok Suk Bae, M.D., Tae Soon Lee, M.D., Sung Dae Park, M.D., Jong Wook Park, M.D.1,
Dong Suk Chun, M.D.2 Although the ‘No-touch’ isolation technique was introduced by Turnbull et al. in 1967, the controversy over whether or not it reduces the risk of metastasis during surgery exists even today. The aim of this study was to evaluate the effect of the ‘No-touch’ isolation technique in primary colorectal cancer surgery.
Methods: The evaluation was done by comparing the levels of CEA and CEA m-RNA expression from the same draining vein before and after tumor mobilization. Blood samples from 25 patients with primary colorectal cancer were collected for analysis. At the time of surgery, the main draining vein from the tumor was isolated and ligated at the proximal end. The 1st blood samples were collected just prior to tumor mobilization, and the 2nd samples right after. Both samples were analyzed for serum CEA level and CEA mRNA expression by using reverse transcriptase polymerase chain reaction (RT-PCR).
Results: The mean CEA value from draining veins after tumor mobilization (8.08±8.98 ng/ml) was significantly higher than it was before mobilization (4.17±4.98 ng/ml). CEA mRNA was detected in 16% (4/25) of the blood specimens post-mobilization, whereas it was detected in only 4% (1/25) of the pre-mobilization samples.
Conclusions: The results suggest the validity of using the ‘No-touch’ isolation technique to reduce the risk of metastasis into the draining vein during mobilization.

국문 초록 (Abstract)

목적: ‘No-touch’ isolation 술식은 아직까지도 술 중 전이의 위험도를 낮추는가에 대해서는 논란의 대상이 되고 있다. 이 술식의 재발률을 분석하기 위해 가장 이상적인 연구방법은 단일기관의 단일 술자에 의해 기존의 술식과 비교하여 연구하는 것이 바람직하지만, 어려움이 있다. 저자들은 대장암에서 이 술식의 종양 조작 전 혈관결찰술이 암전이 위험성을 저하시킬 수 있는가를 실험적 방법으로 확인하고자 본 연구를 시작하였다.
대상 및 방법: 25예의 대장암 환자에서 술 중 종양 조작이 이루어지기 전에 주 배액 정맥을 분리하여 결찰을 하였으며, 종양 조작 전 후에 주 배액 정맥을 통해 각각 정맥혈 채취를 하였다. 이들 정맥혈에서 혈청 CEA 수치 및 RT-PCR을 이용한 CEA m-RNA의 발현 여부를 비교 분석하였다.
결과: 종양 조작 후에 이루어진 배액 정맥혈에서의 평균 혈청 CEA 수치는 8.08±8.98 ng/ml로 종양 조작 전의 평균 혈청 CEA 수치인 4.17±4.98 ng/ml보다 유의하게 증가하였으며(P=0.035), CEA m-RNA의 발현은 종양 조작 후의 정맥혈에서 16% (4/25)로, 종양 조작 전의 정맥혈에서 4% (1/25)보다 유의하게 증가하였다(P=0.00).
결론: ‘No-touch’ isolation 술식 중 종양 조작 전 혈관결찰술은 대장암 세포전이의 위험성을 낮출 수 있는 것으로 생각이 되지만, 술 후 재발률, 사망률 등의 임상적 연구가 더 필요할 것으로 생각된다.

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