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Techniques in Coloproctology

, Volume 22, Issue 7, pp 563–563 | Cite as

Is it correct to perform omentoplasty to repair rectovaginal fistulas in oncological patients?

  • Antonio MacrìEmail author
Correspondence
  • 342 Downloads

Dear Sir,

I read with interest the article by E. Schloericke et al. [1], entitled “Surgical management of complicated rectovaginal fistulas and the role of omentoplasty” published in Techniques in Coloproctology, in which the authors reported their treatment of rectovaginal fistulas in 58 patients, 19 of whom had a history of cancer with a primary localization in the pelvis. There are important considerations to make before transposing the omentum to the pelvis in patients with cancer. As reported in many studies [2], peritoneal carcinomatosis is actually considered a locoregional disease, in which the omentum plays a fundamental role. As reported by Liu [3], invasive peritoneal-exfoliated cancer cells preferentially select the omentum as a predominant target site for cancer cell colonization. Moreover, although the mechanisms underlying peritoneal dissemination have not yet been elucidated, milky spots provide suitable ‘soil’ for cancer cells to implant [4]. Milky spots, described in 1863 by Recklinghausen as white spots in the omentum of young rabbits [5], and in 1921 by Seifert in the human omentum [6], are lymphatic orifices on the surface of the peritoneum that can be considered as open gates for peritoneal-free cancer cells to migrate into the submesothelial space (3). In the light of these considerations, I think that the transposition of the omentum to the pelvis may potentially increase the incidence of cancer recurrence in patients with a history of cancer, especially cancer of gastrointestinal and ovarian origin, and cannot be recommended in the absence of randomized studies that analyze their oncological outcome.

Notes

Compliance with ethical standards

Conflict of interest

The author declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Schloericke E, Zimmermann M, Benecke C et al (2017) Surgical management of complicated rectovaginal fistulas and the role of omentoplasty. Tech Coloproctol 21(12):945–952.  https://doi.org/10.1007/s10151-017-1657-1 CrossRefPubMedGoogle Scholar
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    Macrì A, Arcoraci V, Belgrano V et al (2014) Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: preliminary analysis of a multicentre study. Anticancer Res 34(10):5689–5693PubMedGoogle Scholar
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    Liu J, Geng X, Li Y (2016) Milky spots: omental functional units and hotbeds for peritoneal cancer metastasis. Tumour Biol 37(5):5715–5726CrossRefPubMedPubMedCentralGoogle Scholar
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    Feng S, Feng M, Wenxian Guan (2017) Mechanisms of peritoneal dissemination in gastric cancer (review). Oncol Lett 14:6991–6998PubMedPubMedCentralGoogle Scholar
  5. 5.
    Recklinghausen FV (1863) Uber Eiter und Bindesgewebs-korperchen. Vir Arch Pathol Anat 28:157CrossRefGoogle Scholar
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    Seifert E (1921) Zur Biologie des menschlichen grossen Netzes. Arch Klin Chir 147:510–517Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Peritoneal Surface Malignancy and Soft Tissue Sarcoma ProgramMessina University Medical School HospitalMessinaItaly

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