2 research outputs found
Influence of Peritoneal Trauma on Postoperative Adhesion Formation and Intra-Abdominal Tumour Recurrence
Reduction of peritoneal trauma by using nonsurgical gauze leads to less implantation metastasis of spilled tumor cells
OBJECTIVES: To evaluate whether infliction of peritoneal trauma would
promote tumor cell adherence to damaged peritoneal surfaces; to
investigate whether peritoneal damage could promote tumor growth of
extraperitoneal tumors; and to evaluate whether the amount of trauma
correlated with the degree of tumor cell adherence and local and distant
tumor growth. BACKGROUND DATA: After potentially curative resection of
colorectal carcinoma, the most common site for recurrence is locoregional.
We previously demonstrated that surgical trauma induces a cascade of
events leading to adhesion formation. The same mechanisms may be
responsible for improved tumor cell adherence and growth facilitation in
early local recurrence. METHODS: A reproducible rat model was used in
which peritoneal damage was inflicted by standardized rubbing of the
peritoneum with surgical gauzes of different texture. In the first
experiment, tumor cell adherence and growth at traumatized and
nontraumatized peritoneal sites were assessed semiquantitatively 3 weeks
after perioperative intra-abdominal injection of CC-531 tumor cells. In
the second experiment, the effect of peritoneal trauma on ectopic tumor
growth was investigated (CC-531 implanted under the renal capsule). In the
final experiment, we evaluated how soon after peritoneal traumatization
tumor cell adhesion and growth-promoting factors were active and whether
they could be passively transferred to naive nontraumatized abdominal
cavities. RESULTS: A significant correlation between the amount of
peritoneal trauma and the degree of tumor take at damaged peritoneal
surfaces was found (p < or = 0.018). Tumor take at remote peritoneal sites
not directly traumatized was also significantly higher after severe trauma
than after moderate trauma of the peritoneum (p < or = 0.005). In
addition, a significant correlation between the degree of peritoneal
trauma and the growth of ectopic tumors under the renal capsule was
observed (p < or = 0.009). The final experiment demonstrated that within a
few hours after infliction of peritoneal trauma, tumor growth-promoting
effects could be passively transferred to naive recipients. CONCLUSIONS:
Surgical trauma is an important factor in the promotion of local
recurrence. The enhancing effect of trauma is not restricted to the
inflicted site but rather has a generalized character. Avoidance of
unnecessary surgical trauma by using gentle techniques and materials is
therefore indicated