Reinbach, Diana Helen; (1995) Clinical and experimental studies of locoregional tumour growth in colorectal cancer. Masters thesis (M.S), UCL (University College London).

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Abstract

Local recurrence has been reported in 10–25% of patients following potentially curative resection of colorectal cancer and is a major factor limiting survival. The causes of locoregional recurrence have not been fully defined and this work investigates some factors that may be important. The clinical part of this project studies the effect of a surgeon's specialty interest on specimen resection length. Results show that surgeons with an interest in colorectal surgery perform a more extensive resection of left sided colon and rectal cancer than surgeons with gastrointestinal or other surgical interests. The experimental animal work explores factors such as mode of tumour cell delivery, tissue injury and suture material used on tumour cell adherence to an anastomosis and tumour growth. Results show that viable circulating tumour cells implant at a colonic anastomosis and cause tumour growth in a time dependant fashion. A comparison of the potential for intraluminal (IL), intraperitoneal (IP) and circulating tumour cells to adhere to a colonic anastomosis demonstrates that adherence is significantly greater for IL and IP tumour cells compared to circulating cells. Further experimental - findings suggest that tumour cells from solid organ micrometastases may seed to sites of tissue injury (colonic anastomoses) and lead to tumour growth. Finally, results have shown that the suture material used to repair a colotomy (tissue injury) is more important than the tissue injury itself in tumour cell adherence, with braided material (silk) adhering significantly more tumour cells than monofilament suture material (polypropylene). The role of growth factors was evaluated in a series of experiments: the findings show that the vector used for growth factor delivery (bovine collagen) promotes tumour growth in this animal model. There was no evidence of tumour promotion due to growth factors alone, however, the overwhelming effect of collagen was such that it may have masked any effect from growth factors.

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