Potential for peritoneal cancer cell seeding in endoscopic full-thickness resection for early gastric cancer

Osamu Goto, Masayuki Shimoda, Motoki Sasaki, Yoshiyuki Kiguchi, Yutaka Mitsunaga, Teppei Akimoto, Yasutoshi Ochiai, Ai Fujimoto, Tadateru Maehata, Toshihiro Nishizawa, Hiroya Takeuchi, Yuko Kitagawa, Kaori Kameyama, Naohisa Yahagi

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Background and Aims: During endoscopic full-thickness resection (EFTR) for cancers, whether exposure of the lumen to the abdominal cavity during the procedure is acceptable is controversial because of the potential risk of tumor cell seeding. To assess the possibility of transplantation as a result of contact with tumor cells during the procedure, we prospectively investigated the ability of cancer cells to be detached by touching the tumor surface. Methods: In 48 patients with a single early gastric cancer resected by endoscopic submucosal dissection, stamp cytology was performed by touching the surface of the specimens to glass slides. Samples were obtained from cancerous and noncancerous areas, constituting the study and control groups, respectively. The detection rate of malignant class IV or V (C-IV/C-V) samples was investigated with Papanicolaou staining. The rate of CD44v9-positive cases, a cancer stem cell marker, was assessed in C-IV/C-V samples with immunohistochemical staining. Results: Detection rates of C-IV/C-V samples in the cancerous group (53/192 slides, 27.6%) differed significantly from those of the C-IV/C-V samples in the noncancerous group (0/96 slides, 0%). Among the 53 slides of C-IV/C-V samples in the cancerous group, CD44v9 cells were expressed in 18 slides (34.0%). Conclusions: These data suggest that cancer cells, including cancer stem cells, in early gastric cancers are easily detached via contact with the tumor surface. In EFTR, a nonexposure approach is recommended to avoid the risk of iatrogenic cancer cell seeding via contact with and transplantation of cancer cells.

Original languageEnglish
Pages (from-to)450-456
Number of pages7
JournalGastrointestinal Endoscopy
Issue number2
Publication statusPublished - 2018 Feb

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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