Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World Journal of Gastrointestinal Surgery. Sep 27, 2015; 7(9): 178-184
Published online Sep 27, 2015. doi: 10.4240/wjgs.v7.i9.178
Detection methods and clinical significance of free peritoneal tumor cells found during colorectal cancer surgery
Simone Sibio, Cristina Fiorani, Carmine Stolfi, Andrea Divizia, Roberto Pezzuto, Fabrizio Montagnese, Giulia Bagaglini, Paolo Sammartino, Giuseppe Sigismondo Sica
Simone Sibio, Paolo Sammartino, Department of Surgery Pietro Valdoni, Sapienza University of Rome, 00155 Rome, Italy
Cristina Fiorani, Carmine Stolfi, Andrea Divizia, Roberto Pezzuto, Fabrizio Montagnese, Giulia Bagaglini, Giuseppe Sigismondo Sica, Department of Surgical Science, Tor Vergata University of Rome, 00133 Rome, Italy
Author contributions: Sibio S and Sica GS wrote the paper; Fiorani C, Stolfi C, Divizia A, Pezzuto R, Bagaglini G and Sammartino P performed the literature review; Montagnese F and Sica GS critically reviewed the paper.
Conflict-of-interest statement: All the authors of this manuscript have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Giuseppe Sigismondo Sica, MD, PhD, Department of Surgical Science, Tor Vergata University of Rome, viale Oxford 81, 00133 Rome, Italy. sigisica@gmail.com
Telephone: +39-06-20902927 Fax: +39-06-20902925
Received: March 19, 2015
Peer-review started: March 21, 2015
First decision: April 10, 2015
Revised: June 10, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: September 27, 2015
Abstract

Peritoneal washing is now part of the standard clinical practice in several abdominal and pelvic neoplasias. However, in colorectal cancer surgery, intra-peritoneal free cancer cells (IFCC) presence is not routinely investigated and their prognostic meaning is still unclear. When peritoneal washing results are positive for the presence of IFCC a worse outcome is usually expected in these colorectal cancer operated patients, but it what is not clear is whether it is associated with an increased risk of local recurrence. It is authors’ belief that one of the main reasons why IFCC are not researched as integral part of the routine staging system for colon cancer is that there still isn’t a diagnostic or detection method with enough sensibility and specificity. However, the potential clinical implications of a routine research for the presence IFCC in colon neoplasias are enormous: not only to obtain a more accurate clinical staging but also to offer different therapy protocols, based on the presence of IFCC. Based on this, adjuvant chemotherapy could be offered to those patients found to be positive for IFCC; also, protocols of proactive intraperitoneal chemotherapy could be applied. Although presence of IFCC appears to have a valid prognostic significance, further studies are needed to standardize detection and examination procedures, to determine if there are and which are the stages more likely to benefit from routine search for IFCC.

Keywords: Colorectal cancer, Cytology, Free cancer cells, Peritoneal recurrence, Proactive treatment

Core tip: This invited editorial looks for the role of intra-peritoneal free cancer cells (IFCC) in the surgical practice for colorectal cancer. Prognostic significance of IFCC in colorectal cancer patients is still not clear. Several studies have been published but detection systems are still highly heterogeneous and results remain misleading. Peritoneal cytology could be useful in early-stage cancers to identify subsets of patients with potential worse prognosis, who may be good candidates for adjuvant treatment or even prophylactic intraperitoneal chemotherapy. Current available data need stronger validation to include IFCC in the routine staging protocols of colorectal cancer patients. However, it is the authors’ belief that cancer cells found free in the peritoneum of patients with colon cancer, must have a biological and a clinical role. The means of detection based on real time polymerase chain reaction, will surely add power to conventional cytology and with the improvement in sensibility of the methods the clinical role of IFCC could eventually become clear. New therapy protocols might be applied.