Surgical mesh and cancer risk

Abstract

There is worldwide controversy about the effects of surgical mesh; particularly following adverse events associated with its use for repair of pelvic organ prolapse in women. 1 This led to the USA Food and Drug Administration (USFDA) issuing a Public Health Notification in 2008. 2 These and similar actions in other jurisdictions began a debate on risk versus benefit of surgical procedures using surgical mesh as opposed to traditional suture-based repairs. Interest has focused on urogyecological procedures where there is a large body of data showing the problems associated with mesh use, including erosion through the vaginal epithelium and vaginal scarring. 3,4 The formation of scar tissue involves the deposition of collagen from fibroblasts which are stimulated to divide by transforming growth factor (TGF)-b 2 in response to tissue damage and the resulting inflammatory response. 5 The reported side effect of surgical mesh use are predominantly medium-term (i.e. 1-5 y); these follow up studies focused on quality of life, pain, return of symptoms, dysparuria, etc. and thus are not relevant to tumorigenesis. 6,7 Indeed, it is very unlikely that tumours would manifest in a 5-year timescale. Few data are available to facilitate robust assessment of long-term (>10 y) risks, and for other surgical procedures utilising surgical mesh, including abdominal hernia repair (for which surgical mesh was first used in the 1950s). 2 Long-term hernia repair follow-up studies focused on hernia recurrence, scar pain and cosmetic effects and concluded that mesh was superior to conventional suture-based surgical procedures based on these risk factors. 8,9 A 17-year follow-up study involved palpation to check for 'signs of erosion, extrusion, fistulation and other tissue reactions' after tension-free vaginal tape (TVT) procedures did not report any tumours. 10 However, it is likely that the palpation method would not detect small tumours, and the authors make the point that the amount of mesh implanted when TVT is used is much less than is used for prolapse surgery. 10

Could Microplastics Be a Driver for Early Onset Colorectal Cancer?

“…However, many plastics contain plasticizers (e.g., nonylphenols) which are important to confer specific properties (e.g., malleability)—these plasticizers are not chemically bonded to the plastic polymer, and can therefore leach into the environs of the plastic. This is exemplified by the inflammatory response that surgical mesh can induce when introduced into tissues [ 18 ]. The chemical structure determines the properties of plastics, such as durability, which renders them highly resistant to natural processes of complete degradation.…”