Advertisement

Diseases of the Colon & Rectum

, Volume 40, Issue 9, pp 1085–1088 | Cite as

Use of intraperitoneal 5-fluorouracil and chlorhexidine for prevention of recurrence of perforated colorectal carcinoma in a rat model

  • Michael Stuntz
  • Gerald Wilmoth
  • Jane Ong
  • Bruce Stabile
  • Michael Stamos
Original Contributions
  • 19 Downloads

Abstract

PURPOSE: Colorectal cancer is a prevalent and mortal disease, resulting in nearly 55,000 deaths in the United States annually. Preoperative or intraoperative spillage of tumor cells because of perforation occurs in up to 10 percent of cases. When this spillage occurs, the chance of recurrence and death is dramatically increased. METHODS: In an effort to reduce the chance of recurrence and death, we used a rat model to evaluate the efficacies of intraperitoneal 5-fluorouracil and chlorhexidine in reducing the incidence of recurrence. Rats were injected with 10 mg/kg azoxymethane subcutaneously weekly for 12 weeks to induce colorectal cancers. At 20 weeks, subtotal colectomies were performed on rats with colorectal tumors and without peritoneal implants or liver metastases. At the time of surgery, a cut portion of the tumor was placed in the abdomen for 30 minutes; the rats then randomly received peritoneal irrigation with 5-fluorouracil, chlorhexidine, or sterile water (control). Eight weeks postoperatively a necropsy was performed. At that time, obvious and suspected recurrences and the anastomotic area were sampled for histologic evaluation. RESULTS: Significant differences were seen with chlorhexidinevs.water for gross tumor (P=0.05) and microscopic tumor (P<0.05). 5-Fluorouracil showed a greater rate of abscess formationvs.both control and chlorhexidine (P>0.05). CONCLUSIONS: Use of chlorhexidine intraperitoneal therapy at the time of the operation for perforated colorectal cancer significantly decreases the frequency of gross tumor recurrence but not total recurrences. Intraperitoneal 5-fluorouracil does not significantly decrease recurrence and may increase the risk of abscess when used intraoperatively.

Key words

Rat Intraperitoneal 5-Fluorouracil Chlorhexidine Perforated colorectal cancer Recurrence 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    American Cancer Society. Cancer facts and figures—1994. Atlanta: American Cancer Society, 1994.Google Scholar
  2. 2.
    Slanetz CA Jr. The effect of inadvetent intraoperative perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 1984;27:792–7.PubMedGoogle Scholar
  3. 3.
    Zirngibl H, Husemann B, Hermanek P. Intraoperative spillage of tumor cells in surgery for rectal cancer. Dis Colon Rectum 1990;33:610–4.PubMedGoogle Scholar
  4. 4.
    Markman M. Second-line chemotherapy for refractory cancer: intraperitoneal chemotherapy. Semin Surg Oncol 1994;10:299–304.PubMedGoogle Scholar
  5. 5.
    Nordlinger B, Panis Y, Puts JP, Herve JP, Delelo R, Ballet F. Experimental model of colon cancer: recurrences after surgery alone or associated with intraperitoneal 5-flourouracil chemotherapy. Dis Colon Rectum 1991;34:658–63.PubMedGoogle Scholar
  6. 6.
    Sugarbaker PH, Gianola FJ, Speyer JC, Wesley R, Barofsky I, Meyers CE. Prospective, randomized trial of intravenous 5-fluorouracil in patients with advanced primary colon or rectal cancer. Surgery 1985;98:414–21.PubMedGoogle Scholar
  7. 7.
    Sugarbaker PH, Cunliffe WJ, Belliveau J,et al. Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Semin Oncol 1989;16:83–97.PubMedGoogle Scholar
  8. 8.
    Sugarbaker PH. Intraperitoneal chemotherapy for treatment and prevention of peritoneal carcinomatosis and sarcomatosis. Dis Colon Rectum 1994;37(Suppl):S115–22.PubMedGoogle Scholar
  9. 9.
    Takahashi T, Hagiwara A, Shimotsuma M, Sawai K, Yamaguchi T. Prophylaxis and treatment of peritoneal carcinomatosis: intraperitoneal chemotherapy with Mitomycin C bound to activated carbon particles. World J Surg 1995;19:565–9.PubMedGoogle Scholar
  10. 10.
    Leather AJ, Kocjan G, Savage F,et al. Detection of free malignant cells in the peritoneal cavity before and after resection of colorectal cancer. Dis Colon Rectum 1994;37:814–9.PubMedGoogle Scholar
  11. 11.
    Archer S, Gray B. Intraperitoneal 5-fluorouracil infusion for treatment of both peritoneal and liver micrometastases. Surgery 1990;108:502–7.PubMedGoogle Scholar
  12. 12.
    Long RT, Edwards RH. Implantation metastasis as a cause of local recurrence of colorectal carcinoma. Am J Surg 1989;157:194–201.PubMedGoogle Scholar
  13. 13.
    Umpleby HC, Williamson RC. Anastomotic recurrence in large bowel cancer. Br J Surg 1987;74:873–8.PubMedGoogle Scholar
  14. 14.
    Umpleby HC, Williamson RC. The efficacy of agents employed to prevent anastomotic recurrence in colorectal carcinoma. Ann R Coll Surg Engl 1984;66:192–4.PubMedGoogle Scholar
  15. 15.
    Xu S, Qian L, Zhang Z. The prompt killing effect of chlorhexidine on human colorectal carcinoma cell linesin vitro. Postgrad Gen Surg 1991;3:109–12.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1997

Authors and Affiliations

  • Michael Stuntz
    • 1
  • Gerald Wilmoth
    • 1
  • Jane Ong
    • 1
  • Bruce Stabile
    • 1
  • Michael Stamos
    • 1
  1. 1.Department of SurgeryHarbor-UCLA Medical CenterTorrance

Personalised recommendations