Local treatment of abdominal wound reduces tumor implantation.
OBJECTIVE
Pneumoperitoneum increases the trocar-site tumor implantation rate using a human colon cancer cell line in a hamster model. The purpose of this study was to determine whether local treatment of trocar sites with potential tumoricidal agents can inhibit tumor implantation after pneumoperitoneum.


METHODS
GW-39 human colon cancer cells (0.5 ml of 2.5% v/v; 8.0 x 10(5) cells) were injected throughout the abdomen of 133 Golden Syrian hamsters through a midline incision. The animals were randomized to receive either untreated 5-mm trocars in each abdominal quadrant (group I control, n = 49), trocars dipped in 10% povidone-iodine (group II, n = 53), or trocars coated with 1% silver sulfadiazine (group III, n = 51). The midline wounds were also coated with the respective agents before closing. Pneumoperitoneum was then maintained at 10 mmHg for 10 min, after which the trocar wounds were closed. In group II, the trocar sites were treated with a coat of povidone-iodine after the trocars were withdrawn and before closing. Gross and microscopic tumor implants were analyzed at 7 weeks postoperatively.


RESULTS
The rate of tumor cell implantation at trocar sites was reduced from 93% (172/184) in the control group to 75% (126/168) and 78% (141/180) in groups II and III, respectively (P < 0.0001). Fewer palpable tumors were detected in groups II and III (40% and 23%, respectively) than in the control group (72%, P < 0.0001). Mean tumor mass in group III (0.4+/-0.1 g), but not in group II (1.0+/-0.2 g), was significantly less than that in the control group (1.3+/-0.1 g, P < 0.01). Overall tumor involvement of the larger midline wound was similar for all groups (I = 80%, II = 79%, III = 71%). However, palpable tumors were identified more frequently in group I (67%) than in groups II and III (43%, P < 0.05; 22%, P < 0.01, respectively).


CONCLUSIONS
Pretreatment of abdominal wounds with povidone-iodine or silver sulfadiazine can reduce tumor implantation after pneumoperitoneum in a hamster model.
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J S
JS
Wu
S M
SM
Pfister
M B
MB
Ruiz
J M
JM
Connett
J W
JW
Fleshman
D000009:Abdominal Muscles / Q000473:pathology; D000818:Animals; D003110:Colonic Neoplasms / Q000473:pathology*; D006224:Cricetinae; D006801:Humans; D008647:Mesocricetus; D009366:Neoplasm Seeding; D009368:Neoplasm Transplantation; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011206:Povidone-Iodine / Q000627:therapeutic use; D014407:Tumor Cells, Cultured
D011206:Povidone-Iodine