Detection of circulating tumor cells in patients with non-small cell lung cancer undergoing lobectomy by video-assisted thoracic surgery: a potential hazard for intraoperative hematogenous tumor cell dissemination

J Thorac Cardiovasc Surg. 2000 May;119(5):899-905. doi: 10.1016/S0022-5223(00)70084-5.


Objective: We prospectively tested whether circulating tumor cells can be found in the preoperative, intraoperative, and postoperative peripheral blood of patients with resectable non-small cell lung cancer who undergo video-assisted lobectomy.

Methods: We assayed for carcinoembryonic antigen messenger RNA (mRNA) by reverse transcriptase-polymerase chain reaction in the peripheral blood taken before, during, just after the completion of the lobectomy and then 2 to 3 weeks, and again 5 to 6 weeks, after the operation in 29 patients with pathologic stage I non-small cell lung cancer who underwent video-assisted lobectomy. We also analyzed the prognostic value of carcinoembryonic antigen mRNA expression pattern in an additional 57 patients with stage I non-small cell lung cancer, whose blood samples were previously assayed for carcinoembryonic antigen mRNA.

Results: Of the 29 patients, the preoperative blood samples from 18 patients were negative for carcinoembryonic antigen mRNA. Of these 18 patients, 16 (89%) had positive test results during operation, although the remaining 2 patients (11%) consistently showed negative test results. The occurrence of this change from negative to positive tests results for carcinoembryonic antigen mRNA during video-assisted lobectomy was significantly higher than in patients who underwent open lobectomy in a previous study (18 of 35 patients; 51%; P <.001). In the 57 patients with stage I cancer whose blood samples were previously assayed for carcinoembryonic antigen mRNA, patients with persistently positive test results for carcinoembryonic antigen mRNA before and during operation had a significantly shorter survival when compared with those patients whose test results were persistently positive.

Conclusions: Video-assisted lobectomy, as compared with open lobectomy, for non-small cell lung cancer may increase the risk of seeding tumor cells into the circulation during operation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / blood
  • Carcinoembryonic Antigen / blood*
  • Carcinoembryonic Antigen / genetics
  • Carcinoma, Non-Small-Cell Lung / blood*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / secondary
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Female
  • Humans
  • Lung Neoplasms / blood*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Seeding*
  • Neoplasm Staging
  • Pneumonectomy / adverse effects*
  • Prognosis
  • Prospective Studies
  • RNA, Messenger / analysis*
  • Reverse Transcriptase Polymerase Chain Reaction
  • Thoracic Surgery, Video-Assisted / adverse effects*


  • Biomarkers, Tumor
  • Carcinoembryonic Antigen
  • RNA, Messenger