Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2025; 17(8): 109155
Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.109155
Correlation between laparoscopic radical resection and tumor markers in peritoneal irrigation fluid
Jin-Feng Zhou, Wei Qiu, Jian-Sheng Chen, Bao-Quan Yan, Xiao-Hui Feng, Mei-Zhen Xu, Ji-Ping Yang
Jin-Feng Zhou, Wei Qiu, Jian-Sheng Chen, Bao-Quan Yan, Xiao-Hui Feng, Mei-Zhen Xu, Ji-Ping Yang, Department of Laboratory Medicine, First Hospital of Putian, Putian 351100, Fujian Province, China
Co-first authors: Jin-Feng Zhou and Wei Qiu.
Author contributions: Zhou JF and Qiu W contributed equally to this work; Zhou JF and Qiu W designed the study, they are jointly responsible for data collection and research design, and contributed equally to this study; Chen JS, Yan BQ, Feng XH, Xu MZ, and Yang JP contributed to the analysis of the manuscript; Zhou JF, Qiu W and Yang JP contributed to the data acquisition and writing of this article; All the authors have read and approved the final manuscript.
Supported by Putian Science and Technology Plan Project, No. 2022SY003.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the First Hospital of Putian (No. 2021-019).
Clinical trial registration statement: This study was registered at the Clinical Trial Center (http://www.researchregistry.com) with the registration number: Researchregistry11240.
Informed consent statement: All study participants or their legal guardians provided written informed consent before enrollment in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Ping Yang, MD, Chief Physician, Department of Laboratory Medicine, First Hospital of Putian, No. 449 Nanmen West Road, Chengxiang District, Putian 351100, Fujian Province, China. yjjfjptyjp2004@126.com
Received: April 30, 2025
Revised: May 28, 2025
Accepted: July 7, 2025
Published online: August 27, 2025
Processing time: 116 Days and 18 Hours
Abstract
BACKGROUND

Gastric cancer (GC) is one of the most common malignancies and types of cancer worldwide.

AIM

To compare the differences in tumor markers of GC with GC dissection, we evaluated the efficacy of recent tumor removal.

METHODS

A prospective cohort study was conducted to analyze the clinical data of patients with GC. Patients were divided into two groups based on the surgical approach: The membrane dissection (MD) group, which underwent membrane-guided laparoscopic radical gastrectomy with D2 lymph node dissection plus complete mesocolic excision, and the D2 group, which underwent traditional laparoscopic radical gastrectomy with D2 lymph node dissection. Abdominal lavage fluid was collected pre- and postoperatively from patients in both groups. The expression of carcinoembryonic antigen (CEA) and cytokeratin-19 (CK-19) message RNAs in the abdominal lavage fluid was detected using reverse transcription polymerase chain reaction. The factors influencing the increase of the tumor markers were analyzed, and the short-term efficacy of the two surgery types was compared.

RESULTS

In total, 135 eligible patients were included in this study, with 69 and 66 cases in the MD and D2 groups, respectively. Fourteen patients with benign gastric lesions were selected to detect tumor marker expression. After excluding patients positive for preoperative cancer leakage, we found that 9.52% and 26.67% of patients in the MD and D2 groups developed postoperative CEA positivity, respectively. Multivariate analysis revealed that the degree of differentiation and surgical approach were independent risk factors for postoperative CEA positivity. The surgical approach was an independent risk factor affecting postoperative CK-19 positivity and postoperative CEA and CK-19 positivity. Surgical time, intraoperative blood loss, number of lymph nodes dissected, time to first postoperative flatus, and time to first liquid intake were all significantly different between the two surgical approaches. There were no significant differences in the incision length, duration of postoperative hospital stays, or postoperative complications.

CONCLUSION

MD is a better radical surgical treatment than traditional D2 surgery and is worthy of further clinical promotion and application.

Keywords: Gastric cancer; Membrane anatomy; Abdominal irrigation fluid; Tumor markers; Cancer leakage

Core Tip: This study demonstrates that membrane dissection (MD) guided laparoscopic radical gastrectomy significantly reduces postoperative cancer cell leakage compared to traditional D2 lymph adenectomy. MD showed lower rates of postoperative carcinoembryonic antigen positivity (9.52% vs 26.67%) and cytokeratin-19 positivity, with surgical approach being an independent risk factor for marker positivity. While maintaining similar safety profiles, MD achieved better short-term outcomes including reduced blood loss and faster recovery, suggesting its superiority as a radical surgical approach for gastric cancer. These findings support MD as a promising technique for improving oncological outcomes in gastric cancer surgery.