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J Thorac Cardiovasc Surg 2000;119:899-905
© 2000 The American Association for Thoracic Surgery

General Thoracic Surgery

Detection of circulating tumor cells in patients with non–small cell lung cancer undergoing lobectomy by video-assisted thoracic surgery: A potential hazard for intraoperative hematogenous tumor cell dissemination

From the Department of Surgery II, Kumamoto University School of Medicine,^a Kumamoto, and Department of Thoracic Surgery, Kumamoto Chuo Hospital,^b Kumamoto, Japan.

This work was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Education, Science and Culture of Japan.

Address for reprints: Michio Ogawa, MD, Department of Surgery II, Kumamoto University School of Medicine, Honjo 1-1-1, Kumamoto 860, Japan (E-mail: yamaj{at}kaiju.medic.kumamoto-u.ac.jp ).

Objective: We prospectively tested whether circulating tumor cells can be found in the preoperative, intraoperative, and postoperative peripheral blood of patients with resectable non–small cell lung cancer who undergo video-assisted lobectomy.
Methods: We assayed for carcinoembryonic antigen messenger RNA (mRNA) by reverse transcriptase–polymerase chain reaction in the peripheral blood taken before, during, just after the completion of the lobectomy and then 2 to 3 weeks, and again 5 to 6 weeks, after the operation in 29 patients with pathologic stage I non–small cell lung cancer who underwent video-assisted lobectomy. We also analyzed the prognostic value of carcinoembryonic antigen mRNA expression pattern in an additional 57 patients with stage I non–small cell lung cancer, whose blood samples were previously assayed for carcinoembryonic antigen mRNA.
Results: Of the 29 patients, the preoperative blood samples from 18 patients were negative for carcinoembryonic antigen mRNA. Of these 18 patients, 16 (89%) had positive test results during operation, although the remaining 2 patients (11%) consistently showed negative test results. The occurrence of this change from negative to positive tests results for carcinoembryonic antigen mRNA during video-assisted lobectomy was significantly higher than in patients who underwent open lobectomy in a previous study (18 of 35 patients; 51%; P < .001). In the 57 patients with stage I cancer whose blood samples were previously assayed for carcinoembryonic antigen mRNA, patients with persistently positive test results for carcinoembryonic antigen mRNA before and during operation had a significantly shorter survival when compared with those patients whose test results were persistently positive.
Conclusions: Video-assisted lobectomy, as compared with open lobectomy, for non–small cell lung cancer may increase the risk of seeding tumor cells into the circulation during operation.

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