The injured peritoneum: Consequences of surgery on an organ

__Abstract__ Surgical trauma to the peritoneum is inevitable during abdominal surgery, whether performed by laparoscopy or laparotomy. Obviously, entering the abdominal cavity is an essential prerequisite in order to be able to perform any kind of surgical intervention intra-abdominally. However, among surgeons there is only little awareness of the consequences of this essential part of an abdominal procedure. Postoperative adhesions, responsible for an increased risk of small bowel obstruction, infertility, chronic abdominal pain and considerable difficulties at re-operations, are often taken for granted whereas attempts to prevent them are not being considered. In case of oncological abdominal surgery the traumatised peritoneum may facilitate outgrowth of spilled tumour cells, inducing peritoneal carcinomatosis and hence a worsened outcome for the patient. Increasing the awareness of sequelae of surgical trauma to the peritoneum hopefully leads to a reduction ofthe amount of peritoneal damage during surgery and a decrease in postoperative morbidity for the patient

Clinical relevance of gallbladder polyps; is cholecystectomy always necessary?

Background: Gallbladder polyps are common incidental findings during abdominal ultrasonography. Cholecystectomy is recommended for polyps equal or greater than 10 mm on ultrasound due to their malignant potential. However, the majority of lesions appear to be pseudopolyps with no malignant potential. Our aim was to determine the correlation between ultrasonographic findings and histopathological findings after cholecystectomy for gallbladder polyps in two institutions. Method: A retrospective analysis was performed at two Dutch institutions of patients who underwent cholecystectomy. All cholecystectomies for suspected gallbladder polyps between January 2010 and August 2017 were included. Ultrasonographic and hist

The role of superoxide anions in the development of distant tumour recurrence

We hypothesise that reactive oxygen species (ROS) released from activated polymorphonuclear leucocytes during surgery play a crucial role in enhanced tumour recurrence seen after surgery. Therefore, the effect of ROS on adhesion of tumour cells to microvascular endothelium in a reproducible human in vitro model was studied. Preincubation of microvascular endothelial cells with the superoxide anion producing xanthine-xanthine oxidase complex significantly increased adhesion of the human colon carcinoma cells HT29 (167% vs control, P<0.01), Caco2 (164% vs control, P<0.01) and of the pancreas carcinoma cells PanC1 (180% vs control, P<0.01). Addition of the antioxidant enzymes superoxide dismutase or catalase significantly decreased tumour cell adhesion (P<0.01). Exposure of endothelial cells to superoxide anions increased the apoptotic rate to 7.9 times the normal rate. Additionally, exposure increased expression of the endothelial adhesion molecules E-Selectin, ICAM-1, and VCAM-1 of maximally 170% vs control (P<0.01). In conclusion, this study shows that superoxide anions promote the adherence of tumour cells to the microvasculature by inducing endothelial apoptosis that subsequently induces the expression of various adhesion molecules for tumour cells. This indicates that by tackling the production of ROS preventing tumour recurrence at distant sites might be feasible