The Use of Sodium Hyaluronate–Carboxymethylcellulose (HA-CMC) Barrier in Gynecologic Malignancies: A Retrospective Review of Outcomes
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Concerns exist regarding the safety of sodium hyaluronate–carboxymethylcellulose (HA-CMC, Seprafilm) adhesion barrier in regard to cancer survival as a result of in vitro data demonstrating that hyaluronan, a component of HA-CMC, may promote tumor growth. We sought to determine whether use of HA-CMC is associated with duration of disease-free or overall survival and rates of immediate complication in patients with gynecologic malignancies. We identified 202 consecutive patients with epithelial ovarian, fallopian tube, and primary peritoneal cancer who underwent initial surgical staging or interval debulking at the University of Minnesota between January 2001 and December 2004. Information on patients’ demographics, medical history, surgical procedures, postoperative complications, disease stage, histology, adjuvant therapy, and disease-free and overall survival was collected from medical records. Survival curves were compared between patients receiving or not receiving HA-CMC by stratified Cox regression models, log rank, and Wilcoxon tests. The level of significance was set to alpha = .05 for each test. Eighty patients received intraoperative placement of HA-CMC and 122 did not. Immediate postoperative complication rates were equivalent in both groups. Median follow-up was 2.1 years. There was no difference in disease-free survival (5-year estimate 23.6% vs. 33.3%, P = .80) or overall survival (5-year estimate 29.7% vs. 40.3%, P = .75) between those who received HA-CMC and those who did not. Our retrospective analysis suggests that HA-CMC adhesion barrier does not affect disease-free survival or overall survival; nor does it increase the immediate postoperative complication rates in patients undergoing abdominal surgery for ovarian, fallopian tube, and primary peritoneal carcinomas.
- Bristow RE, Santillan A, Diaz-Montes TP, et al. Prevention of adhesion formation after radical hysterectomy using a sodium hyaluronate–carboxymethylcellulose (HA-CMC) barrier: a cost-effectiveness analysis. Gynecol Oncol. 2007;104:739–46. CrossRef
- Al-Sunaidi M, Tulandi T. Adhesion-related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol. 2006;108:1162–6.
- Al-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol. 1999;180:313–5. CrossRef
- Parker MC, Ellis H, Moran BJ, et al. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 2001;44:822–9. CrossRef
- Becker JM, Dayton MT, Fazio VW, et al. Prevention of postoperative abdominal adhesions by a sodium hyaluronate–based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg. 1996;183:297–306.
- Diamond MP. Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion Study Group. Fertil Steril. 1996;66:904–10.
- Tsuji S, Takahashi K, Yomo H, et al. Effectiveness of antiadhesion barriers in preventing adhesion after myomectomy in patients with uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol. 2005;123:244–8. CrossRef
- Bristow RE, Montz FJ. Prevention of adhesion formation after radical oophorectomy using a sodium hyaluronate–carboxymethylcellulose (HA-CMC) barrier. Gynecol Oncol. 2005;99:301–8. CrossRef
- Toole BP, Wight TN, Tammi MI. Hyaluronan-cell interactions in cancer and vascular disease. J Biol Chem. 2002;277:4593–6. CrossRef
- Gotte M, Yip GW. Heparanase, hyaluronan, and CD44 in cancers: a breast carcinoma perspective. Cancer Res. 2006;66:10233–7. CrossRef
- Carpenter PM, Dao AV. The role of hyaluronan in mesothelium-induced motility of ovarian carcinoma cells. Anticancer Res. 2003;23:3985–90.
- Laurich C, Wheeler MA, Iida J, et al. Hyaluronan mediates adhesion of metastatic colon carcinoma cells. J Surg Res. 2004;122:70–4. CrossRef
- Tan B, Wang JH, Wu QD, et al. Sodium hyaluronate enhances colorectal tumour cell metastatic potential in vitro and in vivo. Br J Surg. 2001;88:246–50. CrossRef
- Hubbard SC, Burns JW. Effects of a hyaluronan-based membrane (Seprafilm) on intraperitoneally disseminated human colon cancer cell growth in a nude mouse model. Dis Colon Rectum. 2002;45:334–41. CrossRef
- Pucciarelli S, Codello L, Rosato A, et al. Effect of antiadhesive agents on peritoneal carcinomatosis in an experimental model. Br J Surg. 2003;90:66–71. CrossRef
- Makrydimas G, Zagorianakou N, Zagorianakou P, et al. CD44 family and gynaecological cancer. In Vivo. 2003;17:633–40.
- Rudzki Z, Jothy S. CD44 and the adhesion of neoplastic cells. Mol Pathol. 1997;50:57–71. CrossRef
- Oikonomakis I, Wexner SD, Gervaz P, et al. Seprafilm: a retrospective preliminary evaluation of the impact on short-term oncologic outcome in colorectal cancer. Dis Colon Rectum. 2002;45:1376–80. CrossRef
- Kusunoki M, Ikeuchi H, Yanagi H, et al. Bioresorbable hyaluronate-carboxymethylcellulose membrane (Seprafilm) in surgery for rectal carcinoma: a prospective randomized clinical trial. Surg Today. 2005;35:940–5. CrossRef
- Beck DE, Cohen Z, Fleshman JW, et al. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum. 2003;46:1310–9. CrossRef
- Salum MR, Lam DT, Wexner SD, et al. Does limited placement of bioresorbable membrane of modified sodium hyaluronate and carboxymethylcellulose (Seprafilm) have possible short-term beneficial impact? Dis Colon Rectum. 2001;44:706–12. CrossRef
- Tang CL, Seow-Choen F, Fook-Chong S, et al. Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision: a prospective, randomized trial. Dis Colon Rectum. 2003;46:1200–7. CrossRef
- Rooney P, Wang M, Kumar P, et al. Angiogenic oligosaccharides of hyaluronan enhance the production of collagens by endothelial cells. J Cell Sci. 1993;105(Pt 1):213–8.
- Ropponen K, Tammi M, Parkkinen J, et al. Tumor cell–associated hyaluronan as an unfavorable prognostic factor in colorectal cancer. Cancer Res. 1998;58:342–7.
- Rooney P, Kumar S, Ponting J, et al. The role of hyaluronan in tumour neovascularization. Int J Cancer. 1995;60:632–6. CrossRef
- Underwood RA, Wu JS, Wright MP, et al. Sodium hyaluronate caroxymethycellulose-based bioresorbable membrane (Seprafilm)—does it affect tumor implantation at abdominal wound sites? Dis Colon Rectum. 1999;42:614–9. CrossRef
- Sasaki T, Shimura H, Tanaka T, et al. Protection of trocar sites from gallbladder cancer implantation by sodium hayluronate shill carboxymethycellulose-based bioresorbable membrane (Seprafilm) in a murine model. Surg Endosc. 2004;18:246–51. CrossRef
- Spirtos NM, Eisenkop SM, Schlaerth JB, et al. Second-look laparotomy after modified posterior exenteration: patterns of persistence and recurrence in patients with stage III and stage IV ovarian cancer. Am J Obstet Gynecol. 2000;182:1321–7. CrossRef
- The Use of Sodium Hyaluronate–Carboxymethylcellulose (HA-CMC) Barrier in Gynecologic Malignancies: A Retrospective Review of Outcomes
Annals of Surgical Oncology
Volume 16, Issue 2 , pp 499-505
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors