title: Distilled water peritoneal lavage after colorectal cancer surgery.
abstract: OBJECTIVE
  Tumor cells exfoliated into the peritoneal cavity during colorectal cancer surgery are viable and tumorigenic and may contribute to peritoneal recurrence. Although commonly used, the tumoricidal effectiveness of antiseptics in peritoneal lavage is doubted because of their chemical alteration by peritoneal secretions. In contrast, osmotic lysis by incubation in distilled water may offer an effective tumoricidal activity. Data defining the susceptibility of colorectal carcinoma cells to osmotic lysis are lacking and hence there is no consensus on optimal lavage methodology.
  
  
  METHODS
  We examined the cytocidal activity of water on colorectal cancer cell lines in culture and determined the effect of peritoneal secretions in vivo on the tumoricidal effectiveness of water.
  
  
  RESULTS
  Incubation of cells in distilled water resulted in cell lysis, with 100 percent lysis achieved after 14 minutes of incubation. In vivo, contamination of lavage water by peritoneal secretions produced a resultant solution with an osmolality of 50 mM. Sequential lavages reduced this contamination, enabling a final resultant solution with an osmolality of 10 mM, which produced 100 percent cell lysis after 32 minutes of incubation.
  
  
  CONCLUSIONS
  Current peritoneal lavage methodology is inadequate because complete cell lysis requires water incubation for longer time periods than is currently practiced. Solutions to this problem are discussed.
authors.affiliation: Department of Colorectal Surgery, West Suffolk Hospital, Bury St. Edmunds, United Kingdom.
authors.forename: Emmanuel L
authors.initials: EL
authors.lastname: Huguet
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Keeling
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology / Q000627:therapeutic use; D001826:Body Fluids; D002452:Cell Count; D018929:Cell Culture Techniques / Q000379:methods; D045744:Cell Line, Tumor; D002470:Cell Survival / Q000187:drug effects; D015179:Colorectal Neoplasms / Q000601:surgery*; D004353:Drug Evaluation, Preclinical; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000592:standards; D016014:Linear Models; D009366:Neoplasm Seeding; D009994:Osmolar Concentration; D009997:Osmotic Pressure; D010533:Peritoneal Lavage / Q000379:methods* / Q000592:standards; D010537:Peritoneum / Q000378:metabolism; D011206:Povidone-Iodine / Q000494:pharmacology / Q000627:therapeutic use; D012965:Sodium Chloride / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D014407:Tumor Cells, Cultured / Q000187:drug effects; D014867:Water / Q000494:pharmacology*
chemical_list: D000891:Anti-Infective Agents, Local; D014867:Water; D012965:Sodium Chloride; D011206:Povidone-Iodine