EXFOLIATED MALIGNANT-CELLS IN GLOVE AND INSTRUMENT WASHINGS FOLLOWINGHEAD AND NECK-SURGERY

Loco-regional recurrence following resection of squamous cell carcinom a of the upper aero-digestive tract is a major problem. Cells exfoliat ed from malignant tumours have been considered capable of implanting a nd giving rise to local recurrence or metastatic deposits. A prospecti ve study was performed examining washings from the gloves and instrume nts used in major head and neck operations to determine if exfoliated cells were indeed present. Following removal of the main tumour specim en all surgeons washed their hands in a solution containing a cell fix ative and all instruments were soaked in the solution. Samples were th en centrifuged and stained using a modified PAP technique. On occasion s nuclear fragments consistent with squamous cell carcinoma were prese nt in both glove and instrument washings. We recommend that all surgeo ns change gloves and instruments following removal of the main tumour specimen and prior to irrigation of the operative field with a tumoric idal agent.