Icodextrin reduces postoperative adhesion formation in rats without affecting peritoneal metastasis.
BACKGROUND
Peroperative peritoneal trauma activates a cascade of peritoneal defense mechanisms responsible for postoperative adhesion formation. The same cascade seems to play a role in the process of intra-abdominal tumor recurrence. Icodextrin is a glucose polymer solution that is absorbed slowly from the peritoneal cavity, allowing prolonged "hydroflotation" of the viscera, thereby decreasing adhesion formation. This study evaluated the adhesion-preventing properties of icodextrin and its effect on peritoneal metastasis.


METHODS
Reproducible rat models of peritoneal trauma were used, allowing semiquantitative scoring of adhesion formation or tumor load. In one experiment, peritoneal trauma was inflicted; one group was treated by peroperative intra-abdominal instillation of 7.5% icodextrin, one by instillation of RPMI (placebo), and one had no instillate (controls). In another experiment involving a different model of peritoneal trauma, the coloncarcinoma cell line CC531 was injected intraperitoneally to induce tumor load, again using these three groups.


RESULTS
Treatment of peritoneally traumatized rats with icodextrin caused a 51% reduction in postoperative adhesion formation ( P < .001). However, peroperative intra-abdominal treatment with icodextrin did not affect intraperitoneal tumor cell adhesion and growth of free intra-abdominal tumor cells in rats with this model of severe peritoneal trauma.


CONCLUSIONS
A 7.5% icodextrin solution is effective in reducing postoperative adhesions without promoting tumor recurrence and therefore may prove useful and safe in oncologic surgery.
van den Tol
Petrousjka
P
Department of General Surgery, University Hospital-Dijkzigt, Rotterdam, The Netherlands.
ten Raa
Sander
S
van Grevenstein
Helma
H
Marquet
Richard
R
van Eijck
Casper
C
Jeekel
Hans
H
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000818:Animals; D002448:Cell Adhesion / Q000187:drug effects; D002455:Cell Division / Q000187:drug effects; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D000077607:Icodextrin; D009368:Neoplasm Transplantation; D010537:Peritoneum / Q000187:drug effects / Q000473:pathology*; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control; D051381:Rats; D011919:Rats, Inbred Strains; D013047:Specific Pathogen-Free Organisms; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control*
D005936:Glucans; D000077607:Icodextrin; D005947:Glucose