Suture-line Implantation in Colorectal Cancer Surgery and Efficacy of Povidone-iodine Solution -An Experimental Study-

Hirotoshi Cho

Department of Surgery, Showa University, School of Medicine (Director: Mitsuo Kusano)

Suture-line implantation of exfoliated tumor cells may account for local recurrence of colorectal cancer, and it has been recommended that the bowel lumen be lavaged during the operation. The aim of this study was to demonstrate exrimentally suture-line implantation and the efficacy of povidone-iodine solution for its prevention. In an in vivo study, free cancer cells of the RCN-9 line were injected into the cecal lumen of Fisher 344 rats, with or without introducing povidone-iodine solution into lavage for five minutes consecutively. Then a linear stapler was placed to resect the upper pole of the cecum. The rats were killed on the 21st postoperative day and examined for the presence of cecal tumors histologically. The group without lavage revealed 73% (8/11) tumor formation. Intra-operative bowel lavage using 5% and 2.5% povidone-iodine solution significantly reduced the incidence of tumor growth (18 and 20%).In an in vitro study, the viability RCN-9 cells was determined by the trypan blue dye exclusion test and MTT assay after contact with povidone-iodine solutions (final concentration 0.0005 to 5%) and normal saline for five minutes. Povidone-iodine solution in excess of 0.16% showed a cytotoxic effect on cancer cells in each technique. We conclude that suture-line implantation may occur in the stapling technique and povidone-iodine solution is useful for prophylaxis against implantation in colorectal cancer surgery.

Key words
suture-line implantation, RCN-9, povidone-iodine, stapling device, colorectal cancer

Reprint requests
Hirotoshi Cho Department of Surgery, Showa University School of Medicine
1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142 JAPAN

Accepted
March 19, 1997

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