Rectal washout eliminates exfoliated malignant cells

Abstract

Rectal washout eliminates exfoliated malignant cells in the rectum in the vicinity of the anastomosis.

Impact of anastomotic leakage on oncological outcome after rectal cancer resection

“…Data from clinical and experimental studies show that irrigation fluid from the rectal stump contains a large number of exfoliated tumour cells 30,31 , which in vitro and in an immunosuppressed animal model have the potential for further growth 32,33 . Other studies have shown that exfoliated tumour cells are regularly found on stapling devices and may be implanted on the staple line 34,35 . However, the rate of local recurrence (in particular anastomotic recurrence) shows no correlation with the detection rate of exfoliated cells so that, under the conditions of local inflammation, the in vivo growth potential of these cells appears to be limited.…”

Intra-operative peritoneal lavage – who does it and why?

“…25 Rectal washout with saline has been shown to reduce the number of cancer cells within the lumen and at the site of the anastomosis. 26,27 The best results, however, come from performing the rectal washout with a hypotonic solution such as water and/or antiseptic. 28,29 To take this evidence further, if the presence of exfoliated cancer cells lying within the peritoneum were a cause of local recurrence, then theoretically, IOPL would be useful to reduce the number of cancer cells and, hence, the future local recurrence rate.…”

Suture-line recurrence at a jejunojejunal anastomosis after gastrectomy for gastric cancer

“…Various agents, such as mercuric chloride [8], mercury bichloride [9], chlorhexidine-cetrimide, povidone-iodine [10], and normal saline [11] have been proposed for intraluminal irrigation to decrease the incidence of suture-line recurrence. However, it is not clear whether cytocidal agents are effective in preventing suture-line recurrence at an anastomosis [12].…”

“…Previous clinical studies have revealed that multiple clusters of malignant cells can collect on a circular stapler used to produce an anastomosis when resecting for rectal cancer [11,13,14]. Gertsch et al [13] and Jenner et al [11] reported that cytology revealed malignant cells in centrifuged saline used for washing circular staplers in nine of ten and eight of ten cases of low anterior resection, respectively.…”

“…Gertsch et al [13] and Jenner et al [11] reported that cytology revealed malignant cells in centrifuged saline used for washing circular staplers in nine of ten and eight of ten cases of low anterior resection, respectively. Such malignant cells that collect on a stapler can be trapped or implanted in the suture line when constructing an anastomosis and hence cause subsequent suture-line recurrence [11,[13][14][15].…”