Effect of intraperitoneal chemotherapy and fibrinolytic therapy on tumor implantation in wound sites

Abstract

Failure of surgical treatment for gastrointestinal cancers is often caused by recurrence of the tumor in traumatized peritoneal surfaces. This study examined the effect of intraperitoneal administration of doxorubicin and recombinant tissue plasminogen activator (rt‐PA), a fibrinolytic agent, on incidence and volume of postoperative tumor implants in peritoneal wounds. Prior to randomization, a surgical wound was created on the right parietal peritoneum of 110 BDIX rats and 6 × 105 DHD/K12 colon cancer cells were inoculated intraperitoneally (ip). The control group was given an intraperitoneal injection of saline. Five groups received 1 mg/kg of ip doxorubicin at different times postoperatively: at the end of surgery (DO), 3 hr after surgery (D + 3), postoperative day 1 (Dl), postoperative day 3 (D3), and postoperative day 7(D7). In a second set of experiments, five groups of rats received, in addition to postoperative doxorubicin, 5 mg/kg of intraoperative ip rt‐PA. Incidence and volume of tumor implants in peritoneal wounds were assessed for each group 20 days after the tumor inoculation. All rats of the control group (incidence = 100%) developed tumor implants in peritoneal wounds. Mean (SD) volume was 16.2 (4.7) mm3. When administered at DO, D + 3, and Dl intraperitoneal doxorubicin reduced significantly the incidence and volume of tumor implants in wounds. Postoperative administration of doxorubicin at D3 and D7 did not affect significantly the incidence and the volume of tumor implants in peritoneal wounds. When rt‐PA was administered intraoperatively, ip injection of doxorubicin at any postoperative timing decreased significantly the incidence and volume of tumor implants. In conclusion, ip doxorubicin administered before postoperative D3 may act on tumor cell implanted in peritoneal wounds. Delayed (D3, D7) ip administration of doxorubicin does not prevent the development of tumor implants in peritoneal wounds. Intraoperative administration of rt‐PA may significantly increase the efficacy of delayed ip chemotherapy. © 1996 Wiley‐Liss, Inc.

Recurrence of gastric cancer in the jejunal pouch after completion gastrectomy

“…Localized tissue trauma such as the creation of a suture line may give rise to the suppression of local immune function [12]. Furthermore, clots generated in traumatized tissue of suture-line are rich in fi brin, and this fi brin gel may trap exfoliated cancer cells [13].…”

Intraoperative versus Early Postoperative Intraperitoneal Chemotherapy after Cytoreduction for Colorectal Peritoneal Carcinomatosis: an Experimental Study

“…It has been described that administration of anticancer agents immediately after tumor cell inoculation can eliminate all disease, whereas late administration (later than 3 days after tumor inoculation, when usually macroscopic disease is present) may slow down tumor growth but cannot be used with curative intent. [16][17][18][19][20] The current study shows, in accordance with the experimental literature mentioned, that the application of intraperitoneal chemotherapy 1 day after surgery is still effective to eliminate microscopic tumor cells after cytoreductive procedures, without use of hyperthermic circumstances. Twelve animals from the EPIC group and five animals from the HIPEC group were alive at the end of the follow-up period of 24 weeks.…”

Efficacy of Cytotoxic Agents for the Prevention of Laparoscopic Port-Site Metastases

“…Alternatively, cells may implant in wounds due to direct contamination from laparoscopic instruments. 2,4,18 For this reason, some authors 6,19 have proposed the use of intraperitoneal chemotherapy as an adjuvant strategy to decrease the incidence of port-site metastases following laparoscopic surgery.…”