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Reduction of Peritoneal Trauma By Using Nonsurgical Gauze Leads to Less Implantation Metastasis of Spilled Tumor Cells

van den Tol, Petrousjka M. M.D.; van Rossen, Elma E. M. M.D.; van Eijck, Casper H. J. M.D., Ph.D.; Bonthuis, Fred Ing; Marquet, Richard L. Ph.D.; Jeekel, Hans M.D., Ph.D.

Advances in Surgical Technique

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 naïve 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 ≤ 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 ≤ 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 ≤ 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 naïve 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.

From the Department of General Surgery, University Hospital-Dijkzigt, Rotterdam, The Netherlands

Address reprint requests to M.P. van den Tol, Department of General Surgery, University Hospital-Dijkzigt, or Dr. Molewaterplein, 40, 3015 GD Rotterdam, The Netherlands.

© Lippincott-Raven Publishers.