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Brief Report | Resident's Forum

Reduced Dissemination of Circulating Tumor Cells With No-Touch Isolation Surgical Technique in Patients With Pancreatic Cancer

Tamara M. H. Gall, BSc, MRCS1; Jimmy Jacob, BSc, MSc2; Adam E. Frampton, MSc, MRCS1; Jonathan Krell, BSc, MRCP2; Charis Kyriakides, MD1; Leandro Castellano, BSc, PhD2; Justin Stebbing, MD, MA, FRCP, FRCPath, PhD2; Long R. Jiao, MD, FRCS1
[+] Author Affiliations
1Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, England
2Division of Oncology, Department of Surgery and Cancer, Imperial Centre for Translational and Experimental Medicine, Imperial College, Hammersmith Hospital, London, England
JAMA Surg. 2014;149(5):482-485. doi:10.1001/jamasurg.2013.3643.
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Circulating tumor cells (CTCs) disseminate from the primary tumor and travel through the bloodstream and lymphatic system. The detection of and/or increase in the number of CTCs during a patient’s clinical course may be a harbinger of forthcoming overt metastasis. We aimed to examine the impact of 2 different surgical techniques, standard (ST) pancreaticoduodenectomy (PD) and no-touch isolation (NT) PD, on tumor behavior and outcome in patients with pancreatic cancer by using CTCs as biomarkers. In this pilot study, patients were randomized to either ST-PD (n = 6) or NT-PD (n = 6). Intraoperatively, blood samples were taken from the portal vein for measurement of CTCs before and immediately after removal of the tumor. An increase in CTCs was seen in 5 of 6 patients (83%) with ST-PD but no patients with NT-PD (P = .003). In the ST-PD and NT-PD groups, median overall survival was 13.0 and 16.7 months, respectively (P = .33); there was no difference in disease-free survival (P = .42). The use of NT-PD significantly reduced the number of CTCs in the portal vein with no benefit in survival outcomes compared with ST-PD, although more extensive studies are required.

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Figure 1.
Identification of Pancreatic Circulating Tumor Cells (CTCs) in the Portal Venous Circulation

A, True CTC that is positive for epithelial cell adhesion molecule, pan-cytokeratin (pan-CK), and 4′,6-diamidino-2-phenylindole (DAPI) but negative for CD45. B, Leukocyte that is positive for CD45. Images are from the CellTracks Analyzer II, which uses fluorescent optics to capture and analyze CTCs that have been immunomagnetically selected.

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Figure 2.
Kaplan-Meier Curve of Overall Survival Comparing No-Touch Isolation Pancreaticoduodenectomy With Standard Pancreaticoduodenectomy

Comparison between groups was made by log-rank test (P = .33).

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