Correlation between laparoscopic radical resection and tumor markers in peritoneal irrigation fluid

Table 1 Comparison of membrane dissection and D2 groups, mean ± SD/n (%)

Basic information	Total (n = 135)	Membrane anatomy group (n = 69)	D2 group (n = 66)	Statistic	P value
Age	67.54 ± 9.46	67.88 ± 9.19	67.18 ± 9.79	t = 0.43	0.668
Sex				χ2 = 0.21	0.650
Male	102 (75.56)	51 (73.91)	51 (77.27)
Female	33 (24.44)	18 (26.09)	15 (22.73)
ASA				-	0.666
I	6 (4.44)	2 (2.90)	4 (6.06)
II	79 (58.52)	42 (60.87)	37 (56.06)
III	50 (37.04)	25 (36.23)	25 (37.88)
BMI	22.48 ± 2.91	22.71 ± 3.06	22.23 ± 2.75	t = 0.96	0.339
AFP	31.29 ± 213.39	26.00 ± 179.35	36.81 ± 245.28	t = -0.29	0.770
CEA	8.62 ± 24.23	7.73 ± 21.06	9.55 ± 27.28	t = -0.44	0.664
CA125	13.89 ± 16.70	15.20 ± 20.59	12.53 ± 11.32	t = 0.93	0.354
CA19-9	284.42 ± 1703.98	196.39 ± 1389.93	376.45 ± 1986.93	t = -0.61	0.541
Tumor maximum diameter (cm)	4.88 ± 2.74	4.81 ± 2.67	4.96 ± 2.82	t = -0.31	0.760
Degree of differentiation				χ2 = 0.02	0.888
Middle/high	54 (40.00)	28 (40.58)	26 (39.39)
Low	81 (60.00)	41 (59.42)	40 (60.61)
Tumor site				χ2 = 7.17	0.067
Top	58 (42.96)	37 (53.62)	21 (31.82)
Middle	24 (17.78)	9 (13.04)	15 (22.73)
Bottom	32 (23.70)	15 (21.74)	17 (25.76)
Mixed	21 (15.56)	8 (11.59)	13 (19.70)
Lauren classification				χ2 = 0.13	0.938
Diffusivity	35 (25.93)	17 (24.64)	18 (27.27)
Mixed	65 (48.15)	34 (49.28)	31 (46.97)
Visible peristalsis	35 (25.93)	18 (26.09)	17 (25.76)
Periodization1				χ2 = 0.65	0.885
T1	23 (17.04)	13 (18.84)	10 (15.15)
T2	15 (11.11)	7 (10.14)	8 (12.12)
T3	57 (42.22)	30 (43.48)	27 (40.91)
T4	40 (29.63)	19 (27.54)	21 (31.82)
N period1				χ2 = 3.33	0.344
N0	42 (31.11)	23 (33.33)	19 (28.79)
N1	23 (17.04)	12 (17.39)	11 (16.67)
N2	22 (16.30)	14 (20.29)	8 (12.12)
N3	48 (35.56)	20 (28.99)	28 (42.42)
TNM grade1				χ2 = 1.39	0.500
I	33 (24.44)	17 (24.64)	16 (24.24)
II	30 (22.22)	18 (26.09)	12 (18.18)
III	72 (53.33)	34 (49.28)	38 (57.58)

¹Tumor node metastasis staging was performed using the American Joint Committee on Cancer tumor node metastasis staging system.

AFP: Alpha fetoprotein; ASA: American Society of Anesthesiologists; BMI: Body mass index; CA125: Carbohydrate antigen 125; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; TNM: Tumor node metastasis.

Table 2 Carcinoembryonic antigen cancer leakage ratios for the membrane dissection and D2 surgeries at different T stages, n (%)

T grade	Total (n = 123)	Membrane anatomy group (n = 63)	D2 group (n = 60)	Statistic	P value
Total T stage				χ2 = 6.15	0.013
CEA -	101 (82.11)	57 (90.48)	44 (73.33)
CEA +	22 (17.89)	6 (9.52)	16 (26.67)
T1					0.435
CEA -	22 (95.65)	13 (100.00)	9 (90.00)
CEA +	1 (4.35)	0 (0.00)	1 (10.00)
T2					1.000
CEA -	10 (76.92)	5 (83.33)	5 (71.43)
CEA +	3 (23.08)	1 (16.67)	2 (28.57)
T3				χ2 = 0.76	0.384
CEA -	44 (86.27)	24 (92.31)	20 (80.00)
CEA +	7 (13.73)	2 (7.69)	5 (20.00)
T4					0.146
CEA -	25 (69.44)	15 (83.33)	10 (55.56)
CEA +	11 (30.56)	3 (16.67)	8 (44.44)

CEA: Carcinoembryonic antigen.

Table 3 Carcinoembryonic antigen + ratios of the membrane dissection and D2 procedures in the T3 + T4 stage, n (%)

T3 + T4	Total (n = 87)	Membrane anatomy group (n = 63)	D2 group (n = 60)	Statistic	P value
CEA				χ2 = 4.72	0.030
CEA -	69 (79.31)	39 (88.64)	30 (69.77)
CEA +	18 (20.69)	5 (11.36)	13 (30.23)

CEA: Carcinoembryonic antigen.

Table 4 Relationship between carcinoembryonic antigen cancer leakage and patient clinical pathology characteristics, n (%)

Variable	Total (n = 123)	CEA - (n = 101)	CEA + (n = 22)	Statistic	P value
Degree of differentiation				χ2 = 7.67	0.006
Medium-high	49 (39.84)	46 (45.54)	3 (13.64)
Low	74 (60.16)	55 (54.46)	19 (86.36)
Violated vasculature				χ2 = 3.88	0.049
Yes	51 (41.46)	46 (45.54)	5 (22.73)
No	72 (58.54)	55 (54.46)	17 (77.27)
T grade					0.049
T1	23 (18.70)	22 (21.78)	1 (4.55)
T2	13 (10.57)	10 (9.90)	3 (13.64)
T3	51 (41.46)	44 (43.56)	7 (31.82)
T4	36 (29.27)	25 (24.75)	11 (50.00)
N grade					0.025
N0	38 (30.89)	35 (34.65)	3 (13.64)
N1	20 (16.26)	19 (18.81)	1 (4.55)
N2	19 (15.45)	14 (13.86)	5 (22.73)
N3	46 (37.40)	33 (32.67)	13 (59.09)
TNM grade				χ2 = 8.87	0.012
I	31 (25.20)	28 (27.72)	3 (13.64)
II	26 (21.14)	25 (24.75)	1 (4.55)
III	66 (53.66)	48 (47.52)	18 (81.82)
Modus operandi				χ2 = 6.15	0.013
Membrane anatomy	63 (51.22)	57 (56.44)	6 (27.27)
D2	60 (48.78)	44 (43.56)	16 (72.73)

CEA: Carcinoembryonic antigen; TNM: Tumor node metastasis.

Table 5 Single analysis affecting carcinoembryonic antigen cancer leakage

Variable	OR (95%CI)	P value
Degree of differentiation		0.011
Low	1.00 (Ref.)
Medium-high	0.19 (0.05-0.68)
N grade		0.049
N0	1.00 (Ref.)
N1	0.61 (0.06-6.32)
N2	4.17 (0.88-19.82)
N3	4.60 (1.20-17.60)
TNM grade		0.027
I	1.00 (Ref.)
II	0.37 (0.04-3.82)
III	3.50 (0.95-12.95)
Modus operandi		0.017
Membrane anatomy	1.00 (Ref.)
D2	3.45 (1.25-9.55)

OR: Odds ratio; CI: Confidence interval; TNM: Tumor node metastasis.

Table 6 ultivariate analysis of carcinoembryonic antigen cancer leakage

Variable	OR (95%CI)	P value
Degree of differentiation		0.013
Low	1.00 (Ref.)
Medium-high	0.17 (0.04-0.77)
Modus operandi		0.013
Membrane anatomy	1.00 (Ref.)
D2	4.23 (1.29-13.43)

OR: Odds ratio; CI: Confidence interval.

Table 7 Cytokeratin-19 cancer leak ratios for two surgeries in different T stages, n (%)

T grade	Total (n = 118)	Membrane anatomy group (n = 63)	D2 group (n = 60)	Statistic	P value
T grade				χ2 = 4.19	0.041
CK-19 -	98 (83.05)	54 (90.00)	44 (75.86)
CK-19 +	20 (16.95)	6 (10.00)	14 (24.14)
T1
CK-19 -	21 (100.00)	12 (100.00)	9 (100.00)
CK-19 +	0 (0.00)	0 (0.00)	0 (0.00)
T2					1.000
CK-19 -	12 (92.31)	6 (100.00)	6 (85.71)
CK-19 +	1 (7.69)	0 (0.00)	1 (14.29)
T3				χ2 = 0.27	0.605
CK-19 -	40 (83.33)	22 (88.00)	18 (78.26)
CK-19 +	8 (16.67)	3 (12.00)	5 (21.74)
T4					0.156
CK-19 -	25 (69.44)	14 (82.35)	11 (57.89)
CK-19 +	11 (30.56)	3 (17.65)	8 (42.11)

CK-19: Cytokeratin-19.

Table 8 Cytokeratin-19 + ratio in T3 + T4 stage, n (%)

T3 + T4	Total (n = 84)	Membrane anatomy group (n = 63)	D2 group (n = 60)	Statistic	P value
CK-19				χ2 = 3.33	0.068
CK-19 -	65 (77.38)	36 (85.71)	29 (69.05)
CK-19 +	19 (22.62)	6 (14.29)	13 (30.95)

CK-19: Cytokeratin-19.

Table 9 Relationship between cytokeratin-19 cancer leakage and patients, n (%)

	Total (n = 118)	CK-19 - (n = 98)	CK-19 + (n = 20)	Statistic	P value
Degree of differentiation				χ2 = 4.27	0.039
Medium-high	48 (40.68)	44 (44.90)	4 (20.00)
Low	70 (59.32)	54 (55.10)	16 (80.00)
T grade					0.015
T1	21 (17.80)	21 (21.43)	0 (0.00)
T2	13 (11.02)	12 (12.24)	1 (5.00)
T3	48 (40.68)	40 (40.82)	8 (40.00)
T4	36 (30.51)	25 (25.51)	11 (55.00)
N grade					0.021
N0	37 (31.36)	35 (35.71)	2 (10.00)
N1	17 (14.41)	16 (16.33)	1 (5.00)
N2	20 (16.95)	15 (15.31)	5 (25.00)
N3	44 (37.29)	32 (32.65)	12 (60.00)
TNM grade					0.010
I	29 (24.58)	28 (28.57)	1 (5.00)
II	24 (20.34)	22 (22.45)	2 (10.00)
III	65 (55.08)	48 (48.98)	17 (85.00)
Modus operandi				χ2 = 4.19	0.041
Membrane anatomy	60 (50.85)	54 (55.10)	6 (30.00)
D2	58 (49.15)	44 (44.90)	14 (70.00)

CK-19: Cytokeratin-19; TNM: Tumor node metastasis.

Table 10 Single analysis of the cytokeratin-19 cancer leakage

Variable	OR (95%CI)	P value
Degree of differentiation		0.047
Low	1.00 (Ref.)
Medium-high	0.31 (0.10-0.98)
TNM grade		0.030
I	1.00 (Ref.)
II	2.55 (0.22-29.93)
III	9.92 (1.25-78.58)
Modus operandi		0.047
Membrane anatomy	1.00 (Ref.)
D2	2.86 (1.02-8.07)

OR: Odds ratio; CI: Confidence interval; TNM: Tumor node metastasis.

Table 11 analysis of the cytokeratin-19 cancer leakage

Variable	OR (95%CI)	P value
Modus operandi		0.048
Membrane anatomy	1.00 (Ref.)
D2	3.15 (0.97-10.23)

OR: Odds ratio; CI: Confidence interval.

Table 12 Concomitant cancer leak ratio for membrane dissection and D2 in different T stages, n (%)

	Total (n = 115)	Membrane anatomy group (n = 63)	D2 group (n = 60)	Statistic	P value
Total T stage				χ2 = 6.11	0.013
CEA and CK-19 -	103 (89.57)	56 (96.55)	47 (82.46)
CEA and CK-19 +	12 (10.43)	2 (3.45)	10 (17.54)
T1 grade
CEA and CK-19 -	21(100.00)	12 (100.00)	9 (100.00)
CEA and CK-19 +	0 (0.00)	0 (0.00)	0 (0.00)
T2 grade					1.000
CEA and CK-19 -	12 (92.31)	6 (100.00)	6 (85.71)
CEA and CK-19 +	1 (7.69)	0 (0.00)	1 (14.29)
T3 grade				χ2 = 0.52	0.470
CEA and CK-19 -	44 (95.65)	23 (100.00)	21 (91.30)
CEA and CK-19 +	2 (4.35)	0 (0.00)	2 (8.70)
T4 grade					0.121
CEA and CK-19 -	26 (74.29)	15 (88.24)	11 (61.11)
CEA and CK-19 +	9 (25.71)	2 (11.76)	7 (38.89)

CEA: Carcinoembryonic antigen; CK-19: Cytokeratin-19.

Table 13 Carcinoembryonic antigen and cytokeratin-19 + ratios in T3 + T4 stage, n (%)

T3 + T4	Total (n = 81)	Membrane anatomy group (n = 63)	D2 group (n = 60)	Statistic	P value
Simultaneous cancer leaks				χ2 = 4.96	0.026
CEA and CK-19 -	70 (86.42)	38 (95.00)	32 (78.05)
CEA and CK-19 +	11 (13.58)	2 (5.00)	9 (21.95)

CEA: Carcinoembryonic antigen; CK-19: Cytokeratin-19.

Table 14 Association between simultaneous cancer leakage of carcinoembryonic antigen and cytokeratin-19 markers and clinicopathological characteristics of patients, n (%)

Variable	Total (n = 115)	CEA and CK-19 - (n = 103)	CEA and CK-19 + (n = 12)	Statistic	P value
Number of positive lymph nodes, median (Q1, Q3)	3.00 (0.00, 9.50)	2.00 (0.00, 8.00)	9.50 (6.25, 21.25)	Z = 2.948	0.004
Degree of differentiation				χ2 = 4.462	0.035
Low	68 (59.13)	57 (55.34)	11 (91.67)
Medium-high	47 (40.87)	46 (44.66)	1 (8.33)
T grade					0.006
T1	21 (18.26)	21 (20.39)	0 (0.00)
T2	13 (11.3)	12 (11.65)	1 (8.33)
T3	46 (40)	44 (42.72)	2 (16.67)
T4	35 (30.43)	26 (25.24)	9 (75.00)
N grade					0.027
N0	37 (32.17)	36 (34.95)	1 (8.33)
N1	16 (13.91)	16 (15.53)	0 (0.00)
N2	19 (16.52)	17 (16.50)	2 (16.67)
N3	43 (37.39)	34 (33.01)	9 (75.00)
TNM grade					0.022
I	29 (25.22)	28 (27.18)	1 (8.33)
II	23 (20)	23 (22.33)	0 (0.00)
III	63 (54.78)	52 (50.49)	11 (91.67)
Modus operandi				χ2 = 6.112	0.013
Membrane anatomy	58 (50.43)	56 (54.37)	2 (16.67)
D2	57 (49.57)	47 (45.63)	10 (83.33)

TNM: Tumor node metastasis; CEA: Carcinoembryonic antigen; CK-19: Cytokeratin-19.

Table 15 Single analysis of the simultaneous cancer leakage of the carcinoembryonic antigen and cytokeratin-19 markers

Variable	OR (95%CI)	P value
Number of positive lymph nodes	1.05 (1.01-1.10)	0.022
Degree of differentiation		0.040
Low	1.00 (Ref.)
Medium-high	0.11 (0.01-0.90)
Modus operandi		0.026
Membrane anatomy	1.00 (Ref.)
D2	5.96 (1.24-28.55)

OR: Odds ratio; CI: Confidence interval.

Table 16 Multivariate analysis of the simultaneous cancer leakage of carcinoembryonic antigen and cytokeratin-19 markers

Variable	OR (95%CI)	P value
Modus operandi		0.042
Membrane anatomy	1.00 (Ref.)
D2	10.33 (1.63-65.65)

OR: Odds ratio; CI: Confidence interval.

Table 17 Comparison of recent surgical outcomes in the membrane dissection and D2 groups, mean ± SD/n (%)

Variable	Total (n = 135)	Membrane anatomy group (n = 63)	D2 group (n = 60)	Statistic	P value
Surgery time (minute)	307.33 ± 46.05	317.07 ± 53.43	297.15 ± 34.34	t = 2.59	0.011
Intraoperative bleeding (mL)	82.48 ± 54.73	73.04 ± 53.66	92.35 ± 54.49	t = -2.07	0.040
Number of lymph node dissections	48.22 ± 15.65	50.84 ± 16.82	45.48 ± 13.93	t = 2.01	0.046
Cut length (cm), median (Q1, Q3)	7.00 (5.00, 8.00)	7.00 (5.00, 8.00)	7.00 (5.00, 8.00)	Z = -0.03	0.972
Time to the first exhaust after surgery (day), median (Q1, Q3)	3.00 (2.00, 4.00)	3.00 (2.00, 4.00)	3.00 (3.00, 4.00)	Z = -2.61	0.009
Time of the first fluid intake (day), median (Q1, Q3)	7.00 (7.00, 8.00)	7.00 (6.00, 7.00)	8.00 (7.00, 8.00)	Z = -6.56	< 0.001
Number of days in hospital after surgery (day), median (Q1, Q3)	11.00 (10.00, 13.00)	11.00 (10.00, 14.00)	11.00 (10.25, 13.00)	Z = -0.17	0.867
Pulmonary infection				χ2 = 0.41	0.523
No	116 (85.93)	58 (84.06)	58 (87.88)
Yes	19 (14.07)	11 (15.94)	8 (12.12)
Anastomotic leakage					1.000
No	133 (98.52)	68 (98.55)	65 (98.48)
Yes	2 (1.48)	1 (1.45)	1 (1.52)
Celiac bleeding					0.489
No	134 (99.26)	69 (100.00)	65 (98.48)
Yes	1 (0.74)	0 (0.00)	1 (1.52)
Ileac passion					0.237
No	133 (98.52)	69 (100.00)	64 (96.97)
Yes	2 (1.48)	0 (0.00)	2 (3.03)
Gastroplegia					0.489
No	134 (99.26)	69 (100.00)	65 (98.48)
Yes	1 (0.74)	0 (0.00)	1 (1.52)
Inconal infection/dehiscence					0.489
No	134 (99.26)	69 (100.00)	65 (98.48)
Yes	1 (0.74)	0 (0.00)	1 (1.52)
Abdominal infection				χ2 = 0.00	1.000
No	132 (97.78)	67 (97.10)	65 (98.48)
Yes	3 (2.22)	2 (2.90)	1 (1.52)
Deep venous thrombosis in the lower limbs				χ2 = 0.13	0.715
No	120 (88.89)	62 (89.86)	58 (87.88)
Yes	15 (11.11)	7 (10.14)	8 (12.12)
Pulmonary embolism				χ2 = 0.13	0.717
No	129 (95.56)	65 (94.20)	64 (96.97)
Yes	6 (4.44)	4 (5.80)	2 (3.03)
postoperative complications				χ2 = 0.55	0.458
No	100 (74.07)	53 (76.81)	47 (71.21)
Yes	35 (25.93)	16 (23.19)	19 (28.79)