Clinical Significance of Measuring Levels of CEA, CA19-9 in Peritoneal Washing Fluid in Patients with Gastric Cancer

PURPOSE: Free cancer cells exfoliated from cancer-invaded serosa contribute to peritoneal dissemination, the most frequent pattern of recurrence in patients with gastric cancer. To detect free cancer cells, CEA and CA19-9 were introduced as the markers of gastric cancer, and many methods, such as cytology, immunoassay, and reverse transcription polymerase chain reaction (RT-PCR), exist for detecting them. The aim of this study is to define the clinical significance of using immunoassay to measure the levels of CEA and CA19-9 in the peritoneal washings in patients with gastric cancer. MATERIALS AND METHODS: The peritoneal washing fluids were obtained from 130 patients with gastric cancer who received a curative gastrectomy, palliative gastrectomy or open and closure. The pCEA and pCA19-9 levels were measured by using immunoassay and cytology. The results were compared with the clinicopathological data. RESULTS: The pCEA and pCA19-9 levels were correlated with tumor invasion, lymph-node metastasis, and stage (P<0.05). CONCLUSION: A correlation was found between elevated pCEA and pCA19-9 levels measured by immunoassay and the TNM stage. Therefore, a combined pCEA and pCA19-9 assay could be a sensitive detector of peritoneal dissemination, as well as a predictor of postoperative prognosis. pCEA and pCA19-9 may also determine the adjuvant management strategy.

Bile Duct Injury during Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy (LC) has become the standard procedure for gallbladder disease. LC is associated with bile duct injury, which can cause serious complications. We evaluate the treatment, results and the relation with cholangiopancreatography for bile duct injury during LC. METHODS: 860 cases of LC were performed from April 2000 to August 2005. Among them, 7 cases of bile duct injury were reviewed for the diagnosis, management and operation findings. RESULTS: According to the Strasberg classification, there were 5 cases of type E, 1 case of type C and 1 case of type D. All of them were identified at operation and they were immediately managed. Among the type E cases, the type E1 was managed by CBD end-to-end anastomosis with internal drainage, type the E2 and type E3 were managed by Roux-en-Y hepaticojejunostomy, the type C were managed by primary repair with T-tube drainage and the type D were managed by primary repair. Although all of cases were visible at the cystic duct on preoperative cholangiopancreatography, we could not identify the type E on the operation findings. CONCLUSION: In this study, although the cystic duct was identified on cholangiopancreatography preoperatively, the possibility of bile duct injury increases if there was severe inflammation and adhesion. For the management of bile duct injury, we recommend CBD end-to-end anastomosis for type E1, Roux-en-Y hepaticojejunostomy for type E2 and E3, and primary repair and/or drainage for type C and D.