povidone-iodine and Colonic-Neoplasms

Patients undergoing elective left colectomy for colonic carcinoma or diverticulosis (n = 341) were randomly assigned to three groups. Patients in groups 1 (102 patients) and 2 (122 patients) had two 5% povidone-iodine enemas whereas those in group 3 (117 patients) had saline enemas. Groups 1 and 3 received 24-hour intravenous cefotaxime sodium and metronidazole hydrochloride. Group 2 received single injections of ceftriaxone sodium (1 g) and ornidazole (1 g). Senna concentrate was administered the evening before surgery. There was no statistically significant difference found between groups 1 and 2 concerning the number of infected patients (eight vs 11), anastomotic leakages (four vs four), extra-abdominal complications (32 vs 29), or infection-related deaths (one vs zero). Despite poorer tolerance, povidone-iodine enema was more effective than saline enemas, as there were less infected patients in group 1 (8%) or groups 1 + 2 (8.5%) than in group 3 (13%). Single-dose ceftriaxone-ornidazole combined with povidone-iodine enemas is effective against infective complications in elective left colonic surgery for carcinoma or diverticular disease. Single-dose antibiotic prophylaxis reduces costs and work for the nursing staff.

Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Cefotaxime; Ceftriaxone; Colectomy; Colonic Neoplasms; Diverticulum, Colon; Drug Tolerance; Enema; Female; Humans; Male; Metronidazole; Middle Aged; Ornidazole; Povidone-Iodine; Prognosis; Risk Factors; Senna Extract; Surgical Wound Infection; Survival Rate

Preoperative mechanical bowel preparation, peroperative topical antiseptic measures, and postoperative antibiotic therapy have all been shown to reduce infection after colorectal surgery. We report the results of a randomised trial of preoperative irrigation with a 10% aqueous solution of povidone-iodine (Betadine) versus water in patients undergoing major resection for large bowel carcinoma. All patients had mechanical bowel preparation, preoperative topical povidone-iodine and per and postoperative antibiotics. Of 22 study patients only one (4.6%) developed abdominal wound infection, whereas in 23 controls nine (39.1%) did so (P less than 0.01). In three of the study patients cultures of swabs taken at operation from the transected bowel ends showed no bacterial growth. Arguably the bacterial population would have been markedly reduced in other patients. These results suggest that povidone-iodine irrigation before large bowel resection reduces wound sepsis.

Topics: Aged; Bacteria; Colonic Neoplasms; Female; Humans; Intestines; Male; Povidone; Povidone-Iodine; Premedication; Rectal Neoplasms; Surgical Wound Infection; Therapeutic Irrigation

Free malignant cells, which are frequently detected in the washing liquid from the peritoneal cavity before and after resection of human colorectal cancer, are suspected to cause recurrent peritoneal cancer. We carried out an experimental study to compare the prophylactic efficacy of washing the peritoneum with several anticancer drugs and the antiseptic povidone-iodine against the development of peritoneal carcinomatosis from colonic origin in rats and nude mice. The in vitro anticancer activity of a short, 15-minute exposure of pirarubicin, doxorubicin, 5-fluorouracil, cisplatin, mitomycin C, and 1% povidone-iodine was first evaluated by an MTT assay on DHD/K12/PROb rat and LS174T human colon cancer cells. For the in vivo experiments, BDIX rats were inoculated intraperitoneally (i.p.) with 1 x 10(6) DHD/K12/PROb cells followed by peritoneal scarring and a colocolic anastomosis. A 15-minute peritoneal washing with the anticancer drugs or povidone-iodine was then performed. Nude mice were i.p.-inoculated with 1 x 10(7) LS174T human cells and treated 2 hours later with i.p. pirarubicin. Only pirarubicin, mitomycin C, and povidone-iodine were fully cytotoxic in vitro against DHD/K12/PROb rat colon cancer cells. In contrast to pirarubicin and povidone-iodine, mitomycin C was not completely active against LS174Tcells. In vivo, pirarubicin cured DHD/K12/PROb-inoculated rats, even at the site of the peritoneal scarring and intestinal anastomosis. i.p. pirarubicin prevented the development of peritoneal carcinomatosis and liver metastasis in LS174T-inoculated mice. i.p. washing with pirarubicin cured 2-day-old, but not 7-day-old, peritoneal carcinomatosis in rats. Short exposure to i.p. pirarubicin is nontoxic and more active than povidone-iodine and other anticancer drugs in preventing the development of peritoneal carcinomatosis from colonic origin in rats and mice. The prophylactic effect of preoperative peritoneal washing with pirarubicin on the development of recurrent peritoneal cancer should be evaluated in a randomized clinical trial.

Topics: Animals; Anti-Infective Agents, Local; Antineoplastic Agents; Carcinoma; Cell Line, Tumor; Colonic Neoplasms; Doxorubicin; Immunosuppressive Agents; Injections, Intraperitoneal; Male; Mice; Mice, Nude; Neoplasm Seeding; Peritoneal Lavage; Peritoneal Neoplasms; Pharmaceutical Solutions; Povidone-Iodine; Rats

Reports of metastatic spread of colon and rectal cancer to port sites after laparoscopic resection of potentially curable lesions has raised doubt regarding the efficacy and safety of laparoscopic technology in cancer surgery. Experimental study in animals has led us to believe that the mode of spread of these metastases is via the direct route. We hypothesized, therefore, that we could decrease the rate of trocar-site recurrences by treating the individual port sites with a topical tumoricidal agent.. Male BD-IX rats weighing 240 to 360 g were injected with syngeneic colon cancer to simulate free intraperitoneal cancer spread to trocar sites. All rats were subjected to a sham laparoscopic operation after 2 x 10(5) viable cancer cells had been injected into their peritoneal cavities. Five-millimeter trocars were inserted into each rat after abdominal insufflation to 10 mm Hg. Pneumoperitoneum was maintained for 10 minutes before the trocars were removed simultaneously. Trocar sites were then subjected to one of three treatments, with each animal receiving a maximum of two different treatments. Sites were treated with 70% ethanol (N = 42), povidine/ iodine (N = 40), or no topical treatment (N = 46). Three weeks later, the animals were euthanized and autopsied. Subcutaneous tumors at trocar sites or tumors with >50% volume within the wound were considered implants.. Control sites revealed a metastasis rate of 41% (19/46). The tumor implant rate was 36% (15/42) at alcohol-treated sites and 20% (8/40) at sites treated with povidone-iodine (P < 0.05).. Topical administration of povidone-iodine to trocar wounds after laparoscopic surgery can significantly reduce the incidence of port-site metastasis in a syngeneic animal model of colon cancer.

Topics: Administration, Topical; Alcohols; Animals; Antineoplastic Agents; Colonic Neoplasms; Disease Models, Animal; Male; Neoplasm Recurrence, Local; Neoplasm Seeding; Povidone-Iodine; Rats

A generally accepted approach to prevent tumor implantation with laparoscopic surgery does not exist. Alternative gases in combination with intraperitoneal instillation of different antiadherent or cytotoxic agents have not been evaluated.. The effect of taurolidine, heparin, and povidone-iodine on the growth of colon adenocarcinoma DHD/K12/TRb was measured in rats undergoing laparoscopy with carbon dioxide (n = 40), helium (n = 40), or xenon (n = 40). In the procedure, 10(4) tumor cells were administered intraperitoneally, and pneumoperitoneum was established over 30 min at 8 mmHg with the different gases. The rats additionally received intraperitoneal instillation with one of the following: 1 ml of Ringer's solution, 1 ml of 0.5% taurolidine, 1 ml 0.5% taurolidine with heparin (10 U/ml), or 1 ml 0.25% of povidone-iodine. Tumor growth was measured after 4 weeks.. Median intraperitoneal tumor weight was lower in rats receiving taurolidine (CO(2): 10 mg; helium: 50 mg; xenon: 39.5 mg) or taurolidine with heparin (CO(2): 4 mg; helium: 4.5 mg; xenon: 46.5 mg) in all gas groups than in the control groups (CO(2): 427 mg; helium: 268 mg; xenon: 345 mg) (p < 0.001). Whereas povidone-iodine caused significantly lower tumor growth in the CO(2) group (56.5 mg) (p < 0.01), the combination of helium (145 mg) and xenon (457 mg) with povidone-iodine produced no reduction of tumor growth as compared with the control groups (helium: 268 mg; xenon: 345 mg).. Taurolidine and taurolidine with heparin significantly inhibit intraperitoneal tumor growth, with different gases used for pneumoperitoneum. Only povidone-iodine caused significant decrease of tumor growth in combination with CO(2). The combination of xenon and povidone-iodine should not be used in patients with cancer because of increased tumor growth.

Topics: Adenocarcinoma; Animals; Anti-Infective Agents; Anticoagulants; Carbon Dioxide; Colonic Neoplasms; Heparin; Instillation, Drug; Laparoscopy; Male; Neoplasm Seeding; Pneumoperitoneum, Artificial; Povidone-Iodine; Rats; Taurine; Thiadiazines; Tumor Cells, Cultured

Therapeutic strategies to prevent port site recurrences in laparoscopy surgery of malignancies have not been investigated until now.. The effects of taurolidine, heparin, and povidone iodine on the growth of rat and human colon adenocarcinoma as well as gallbladder carcinoma were investigated in vitro. Furthermore, cytokine release of growth-stimulating IL-1beta by peritoneal macrophages was measured after incubation with carbon dioxide and additional incubation with the different agents. In the third experiment, prevention of intra- and extraperitoneal metastases by intraperitoneal instillation of the different agents during laparoscopy was investigated in a colon carcinoma model in the rat. Tumor cells were administered intraperitoneally in 100 rats, and pneumoperitoneum (8 mm Hg) was established over 30 min with carbon dioxide. Rats received either tumor cells, cells + heparin, cells + povidone iodine, cells + taurolidine, or cells + taurolidine + heparin.. In vitro, tumor cell growth decreased after incubation with taurolidine, taurolidine/heparin, and povidone iodine. Cytokine release was stimulated by incubation with carbon dioxide and could only be suppressed by incubation with taurolidine in vitro. In vivo, intraperitoneal tumor weight was lower in rats receiving heparin (251 +/- 153 mg) and povidone iodine (134 +/- 117 mg) compared to the control group (541 +/- 291 mg), but even less when taurolidine (79 +/- 82 mg) or taurolidine/heparin (18.3 +/- 30 mg) were instilled.. Heparin slightly inhibits intraperitoneal tumor growth in vivo, while povidone iodine and taurolidine cause a significant decrease in tumor cell growth in vitro as well as intraperitoneal tumor growth in vivo. Cytokine release of peritoneal macrophages is only suppressed by taurolidine. Total tumor take and trocar metastases are only suppressed by taurolidine and taurolidine/heparin.

Topics: Adenocarcinoma; Animals; Anti-Infective Agents, Local; Carbon Dioxide; Colonic Neoplasms; Gallbladder Neoplasms; Heparin; Humans; Interleukin-1; Laparoscopy; Macrophages, Peritoneal; Male; Neoplasm Metastasis; Neoplasm Seeding; Peritoneal Cavity; Povidone-Iodine; Rats; Rats, Inbred Strains; Taurine; Thiadiazines; Tumor Cells, Cultured

Tumoricidal agents have been used to kill viable exfoliated tumour cells following colorectal cancer surgery. Recent in vivo experiments have thrown some doubt on the tumoricidal activity of povidone-iodine.. The cytotoxic effect of distilled water and of povidone-iodine at 0.04, 0.4, 0.8, 2 and 4 per cent final concentrations on human SW620 colonic cancer cells in the presence of red blood cells, purified haemoglobin and red blood cell (RBC) membranes, plasma, albumin, faeces and bacteria was investigated. Cell viability was assessed using the trypan blue assay and MTT test.. The presence of albumin and plasma decreased the tumoricidal activity of povidone-iodine except for the highest concentration tested. Bacterial suspension did not influence the efficacy of povidone-iodine. Faecal material was found to have an intrinsic tumoricidal effect. Both intact and lysed RBCs very strongly inhibited the tumoricidal activity of all povidone-iodine concentrations tested. This inhibitory effect was due to haemoglobin, but not to RBC membranes.. Low concentrations of povidone-iodine fail to kill all 'exfoliated' cancer cells in the presence of proteins, intact or lysed RBCs. Therefore, washing out of these organic materials before application of a relatively high povidone-iodine concentration (e.g. 5 per cent or greater) may be more useful in killing viable exfoliated tumour cells during surgery for colorectal cancer.

Topics: Antineoplastic Agents; Bacterial Physiological Phenomena; Cell Survival; Colonic Neoplasms; Dose-Response Relationship, Drug; Erythrocytes; Feces; Hemoglobins; Humans; Neoplasm Recurrence, Local; Plasma; Povidone-Iodine; Serum Albumin

Pneumoperitoneum increases the trocar-site tumor implantation rate using a human colon cancer cell line in a hamster model. The purpose of this study was to determine whether local treatment of trocar sites with potential tumoricidal agents can inhibit tumor implantation after pneumoperitoneum.. GW-39 human colon cancer cells (0.5 ml of 2.5% v/v; 8.0 x 10(5) cells) were injected throughout the abdomen of 133 Golden Syrian hamsters through a midline incision. The animals were randomized to receive either untreated 5-mm trocars in each abdominal quadrant (group I control, n = 49), trocars dipped in 10% povidone-iodine (group II, n = 53), or trocars coated with 1% silver sulfadiazine (group III, n = 51). The midline wounds were also coated with the respective agents before closing. Pneumoperitoneum was then maintained at 10 mmHg for 10 min, after which the trocar wounds were closed. In group II, the trocar sites were treated with a coat of povidone-iodine after the trocars were withdrawn and before closing. Gross and microscopic tumor implants were analyzed at 7 weeks postoperatively.. The rate of tumor cell implantation at trocar sites was reduced from 93% (172/184) in the control group to 75% (126/168) and 78% (141/180) in groups II and III, respectively (P < 0.0001). Fewer palpable tumors were detected in groups II and III (40% and 23%, respectively) than in the control group (72%, P < 0.0001). Mean tumor mass in group III (0.4+/-0.1 g), but not in group II (1.0+/-0.2 g), was significantly less than that in the control group (1.3+/-0.1 g, P < 0.01). Overall tumor involvement of the larger midline wound was similar for all groups (I = 80%, II = 79%, III = 71%). However, palpable tumors were identified more frequently in group I (67%) than in groups II and III (43%, P < 0.05; 22%, P < 0.01, respectively).. Pretreatment of abdominal wounds with povidone-iodine or silver sulfadiazine can reduce tumor implantation after pneumoperitoneum in a hamster model.

Topics: Abdominal Muscles; Animals; Colonic Neoplasms; Cricetinae; Humans; Mesocricetus; Neoplasm Seeding; Neoplasm Transplantation; Pneumoperitoneum, Artificial; Povidone-Iodine; Tumor Cells, Cultured

Previously, we have assessed the efficacy of different cytotoxic agents on the viability of SW620 human colonic carcinoma cells in vitro. In this study, we have investigated the tumoricidal efficacy of some antiseptic agents on SW620 human colonic carcinoma cells which were subsequently inoculated into severe combined immunodeficient (SCID) mice. An inoculum of 5 x 10(6) cells suspended in 200 microliters buffer solution was found to be the minimum number of cells needed to result in tumour growth within 8 weeks after subcutaneous injection into SCID mice. The integrity of the cells was assessed in vitro with the trypan blue exclusion test after 30 min incubation in distilled water (DW), chloramine 0.5% in DW and polyvinyl pyrrolidone iodine (PVP-I) 0.01, 0.05, 0.1 and 5% in DW. DW and PVP-I 0.01% were not tumoricidal, neither in vitro nor in vivo. In contrast, PVP-I 5% and chloramine 0.5% 'killed' all or almost all tumour cells in vitro and prevented their growth in vivo. PVP-I 0.05 and 0.1% were less effective in vitro than 5%, but could prevent in vivo proliferation unless an adjustment of the residual number of viable tumour cells was performed. These data indicate the importance of the amount of the tumour inoculum and hence the need to use a maximally effective 'killing' agent.

Topics: Animals; Anti-Infective Agents, Local; Carcinoma; Cell Count; Cell Survival; Chloramines; Colonic Neoplasms; Female; Humans; Male; Mice; Mice, SCID; Neoplasm Transplantation; Neoplasms, Experimental; Povidone-Iodine; Tumor Cells, Cultured

Suture implantation of viable exfoliated tumour cells may be responsible for local recurrence of colorectal cancer. Using a colon cancer cell line, we obtained a suture implantation without intraperitoneal metastasis in about 80% of the control animals, when sacrificed on the 2nd postoperative week. The cytotoxic efficacy of povidone-iodine (PVP-I) was tested in vivo by a rat model with viable intracaecal tumour cells, and in vitro by trypan blue exclusion and the MTT assay. In vivo PVP-I at 5% significantly reduced the incidence of tumour growth, while the product at 2.5% had a significant effect in only the monofilament polypropylene group. In an in vitro toxicity study, PVP-I higher than 0.16% was effective at killing almost all tumour cells. PVP-I had effective cytotoxicity in vivo and in vitro, being less cytotoxic in vivo than in vitro.

Topics: Animals; Cell Death; Colonic Neoplasms; Colorectal Neoplasms; In Vitro Techniques; Male; Neoplasm Recurrence, Local; Neoplasm Seeding; Povidone-Iodine; Rats; Rats, Inbred F344; Solutions; Sutures; Tumor Cells, Cultured

Forty-eight of 72 surgeons canvassed in the South West of England (67%) routinely use an intraluminal cytotoxic agent to prevent suture-line recurrence following partial resection of the large bowel for cancer. The most popular agents are chlorhexidine-cetrimide preparations (n = 14), mercuric perchloride (12), povidone-iodine (7) and water (12); noxythiolin, sodium hypochlorite and silver nitrate are used occasionally. The mean duration of treatment is 2 minutes. When assayed for cytotoxity against tumour cells freshly prepared from human colorectal carcinomas (n = 10), both chlorhexidine-cetrimide and povidone-iodine were rapidly lethal at a wide range of concentrations (5-100%). Mercuric perchloride (0.2%) was similarly effective, but up to 20% of tumour cells remained viable after exposure to noxythiolin and nearly 30% with water alone. Chlorhexidine-cetrimide and povidone-iodine are the agents of choice to kill malignant cells exfoliated into the colorectal lumen.

Topics: Anti-Infective Agents, Local; Cell Survival; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Colonic Neoplasms; Humans; Mercuric Chloride; Mercury; Neoplasm Metastasis; Neoplasm Recurrence, Local; Noxythiolin; Postoperative Complications; Povidone-Iodine; Rectal Neoplasms; Water

A technique for intraoperative segmental preparation of the large bowel, using 10% povidone iodine, was evaluated in 25 patients undergoing elective colon resection. Qualitative and quantitative bacteriology was obtained from the normal bowel content and from segments of colon treated with povidone iodine or normal saline. Forty-five of 50 segments treated with povidone iodine demonstrated no growth, whereas the segments injected with normal saline maintained bacterial counts of 3.5 x 10(8) colony forming units per milliliter. There were no septic complications in this group of patients and the levels of triiodothyroninc and thyroxin remained unchanged despite a substantial absorption of iodine, as demonstrated by protein-bound iodine determinations. Intraoperative segmental preparation of the colon with 10% povidone iodine is a simple technique that may be useful in the enhancement of other methods of bowel preparation by further reducing the endogenous bacterial inoculum at the time of transection of the colon.

Topics: Adult; Aged; Bacteria; Carcinoma; Colon; Colonic Diseases; Colonic Neoplasms; Humans; Iodine; Middle Aged; Povidone; Povidone-Iodine; Thyroxine; Triiodothyronine