Post written by Osamu Goto, MD, PhD, from the Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
This article is focusing on the importance of non-exposure technique in local resection for early gastric cancers. We prospectively investigated the ability of cancer cells to be detached by touching the tumor surface, to assess the possibility of transplantation due to contact with tumor cells by exposure technique.
It is controversial whether cancer cells can be translocated from the stomach to the abdominal space in an opening technique of gastrectomy, not by spilling the gastric juice but by touching exposed cancer cells with surgical instruments.
In early gastric cancers resected by endoscopic submucosal dissection, stamp cytology was performed by touching the surface of the specimens to glass slides. We demonstrated that cancer cells, including cancer stem cells, were easily detached via contact with the tumor surface. Therefore, in local resection including endoscopic full-thickness resection, a non-exposure approach should be recommended to avoid the risk of iatrogenic cancer cell seeding via contact with and transplantation of cancer cells. It would be desirable to investigate the ability of detached cancer cells to survive and grow in vitro as the next step.
Some non-exposed endoscopic full-thickness resection techniques with or without laparoscopic assistance have been introduced. These techniques would be promising as minimally-invasive surgery for cancers or ulcerated submucosal tumors.
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