GE Mingª²Jian1, SHI De2, WU Qingª²Chen1, WANG Mei3, LI Qiang1, LI Liangª²Bin1

    1Department of Thoracic Surgery, 2Department of General Surª²gery, 3Department of Clinical Laboratory, First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China

    ¡¾Abstract¡¿ AIM: To assess whether surgical manoeuvre or resection of lung cancer could lead to haematogenous dissemination of malignant cells, to monito the quantity and timing of the shedding of lung cancer cells into the circulation of patients by fqRTª²PCR before, during and after surgery, and to determine the relationship between the sequence of vessel ligation and the haematogenous dissemination of cancer cells during operation. METHODS: Sixtyª²nine peripheral blood samples were collected 1 d before operation, during operation and 7 d after operation from 23 consecutive patients with nonª²small cell lung cancer who underwent surgical resection with curative intention. All patients were randomly assigned before the operation to 2 surgical procedure groups according to the order of vessel ligation (PVª²first group and PAª²first group). Additionally, 10 patients with benign lung disease served as control subjects undergoing surgical resection. All the peripheral blood samples were subjected to fqRTª²PCR with carcinoembryonic antigen as marker. RESULTS: The level of CEA mRNA in peripheral blood (PB) ascended contiª²nuously within this period. The postoperative value (D7) was significantly higher than that of preoperation (D-1) (P=0.000) and that of operative day (D0) (P=0.000). There was a striking difference between adenocarcinoma and squamous carcinoma (P=0.0375). The values of CEA mRNA in PB between PVª²first group and PAª²first group were significantly different (P=0.045). At the same time, there was a correlation between preoperative Tª²stage and perioperative CEA mRNA in PB (P=0.025). Among the 23 cases, 10 cases were positive (43.5%). Both the control subjects and the volunteers were negative. CONCLUSION£ºA considerable proportion of patients who appear to have resectable nonª²small cell lung cancer might be regarded as having systemic disease, which is often undetectable by current tumour staging method. CEAª²expressing tumour cells are disseminated mostly postoperatively, which may potentially be the source of recurrence or metastases. Surgical manipulation can promote the release of tumour cells into the blood stream, but the ligation of PV before the ligation of the PA may partly prevent such release during surgery. ......