povidone-iodine and Colorectal-Neoplasms

Povidone-iodine solution (Betadine) has long been accepted as an effective topical broad spectrum antiseptic, disinfectant, and tumoricidal agent. In colorectal operations, this solution generally has been used for the purpose of minimizing postoperative septic complications and reducing cancer recurrence, although the optimal application, advantages, and undesirable side effects have been debated. With limited prospective, randomized, controlled trials and insufficient data available, this article examines the safe and effective clinical applications of this solution for colorectal operations.

Topics: Animals; Anti-Infective Agents, Local; Colorectal Neoplasms; Colorectal Surgery; Humans; Neoplasm Seeding; Povidone-Iodine; Skin; Surgical Wound Infection

The anti-infective actions of povidone-iodine (PVI) and sodium hypochlorite enemas are different.. Prospective, randomized, single-blind study.. Multicenter.. Five hundred seventeen consecutive patients with colorectal carcinoma or sigmoid diverticular disease undergoing elective open colorectal resection, followed by primary anastomosis.. All patients received senna (1-2 packages diluted in a glass of water) at 6 pm the evening before surgery. Patients were administered two 2-L aqueous enemas of 5% PVI (n = 277) or 0.3% sodium hypochlorite (n = 240) at 9 pm the evening before surgery and at 3 hours before operation. Intravenous ceftriaxone sodium (1 g) and metronidazole (1 g) were administered at anesthetic induction.. Rate of patients with 1 infective parietoabdominal complication or more.. The percentages of patients with 1 infective parietoabdominal complication or more did not differ between the 2 groups (13.7% in the PVI-treated group vs 15.0% in the sodium hypochlorite-treated group). Tolerance was better in the PVI-treated group than in the sodium hypochlorite-treated group (79.4% vs 67.9%), with fewer patients experiencing abdominal pain (13.0% vs 24.6%) or discontinuing their preparation (3.0% vs 9.0%) (P=.02 for all). There were more patients with malaise in the PVI-treated group than in the sodium hypochlorite-treated group (9.1% vs 4.9%, P<.05). Three patients in the sodium hypochlorite-treated group had necrotic ulcerative colitis.. When antiseptic enemas are chosen for mechanical preparation before colorectal surgery, PVI should be preferred over sodium hypochlorite because of better tolerance and avoidance of necrotic ulcerative colitis.

Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Anti-Infective Agents, Local; Colon; Colorectal Neoplasms; Disinfectants; Diverticulum, Colon; Elective Surgical Procedures; Enema; Female; Humans; Male; Middle Aged; Povidone-Iodine; Preoperative Care; Prospective Studies; Rectum; Sigmoid Diseases; Single-Blind Method; Sodium Hypochlorite

Although peritoneal lavage with povidone-iodine (PVPI) is frequently performed after surgery on the gastrointestinal tract, the effects of PVPI on the intestinal epithelial barrier are unknown. The purpose of this study was to investigate the effects of abdominal irrigation with PVPI on the intestinal epithelial barrier in a colorectal cancer (CRC)-induced rat model.. The CRC model was induced in rats with azoxymethane and dextran sodium sulfate. Next, a total of 24 male CRC-induced rats were randomly divided into three groups (n = 8): (1) a sham-operated group, (2) an NS group (peritoneal lavage 0.9% NaCl), and (3) a PVPI group (peritoneal lavage with 0.45%-0.55% PVPI). The mean arterial pressure was continuously monitored throughout the experiment. The levels of plasma endotoxin and D-lactate, blood gases, and protein concentration were measured. The ultrastructural changes of the epithelial tight junctions were observed by transmission electron microscopy.. The mean arterial pressure after peritoneal lavage was lower in the PVPI group than that in the NS group. The protein concentration and levels of endotoxin and D-lactate were higher in the PVPI group than they were in the PVPI group. In addition, PVPI treatment resulted in a markedly severe metabolic acidosis and intestinal mucosal injury compared with NS rats.. Peritoneal lavage with PVPI dramatically compromises the integrity of the intestinal mucosa barrier and causes endotoxin shock in CRC rats. It is unsafe for clinical applications to include peritoneal lavage with PVPI in colorectal operations.

Topics: Acidosis; Animals; Anti-Infective Agents, Local; Azoxymethane; Bacterial Translocation; Colorectal Neoplasms; Dextran Sulfate; Endotoxins; Gastrointestinal Microbiome; Humans; Intestinal Mucosa; Male; Microscopy, Electron, Transmission; Neoplasms, Experimental; Peritoneal Absorption; Peritoneal Lavage; Permeability; Povidone-Iodine; Rats; Rats, Sprague-Dawley; Shock, Septic; Tight Junctions

The Centers for Disease Control and Prevention guideline recommended the use of 2% chlorhexidine as a percutaneous disinfectant for central venous catheter (CVC) insertion. However, in Japan, 0.05% chlorhexidine is commonly used as well as 10% povidone-iodine, instead of 2% chlorhexidine.. It was the aim of this study to examine whether the use of 0.05% chlorhexidine is inferior to conventional 10% povidone-iodine as a percutaneous disinfectant for preventing CVC-related bloodstream infection (CVC-RBSI).. Between September 2006 and July 2008, the time interval from insertion to development of CVC-RBSI was compared prospectively between patients prepared with 0.05% chlorhexidine (group 1, n = 286 CVCs) and those prepared with conventional 10% povidone-iodine (group 2, n = 298 CVCs).. Two hundred and thirty-nine patients received 584 CVCs for a total of 6,205 catheter-days. CVC-RBSI (3.22 per 1,000 catheter-days) was diagnosed in 20 cases. There were no significant differences in patient background factors between group 1 and 2, except for blood culture positivity (p = 0.0450). However, Kaplan-Meier analysis and the log rank test revealed no significant difference between group 1 and 2 in the time interval from insertion until development of CVC-RBSI.. Use of 0.05% chlorhexidine is not inferior to conventional 10% povidone-iodine as a cutaneous disinfectant for the prevention of CVC-RBSI.

Topics: Aged; Anti-Infective Agents, Local; Catheter-Related Infections; Catheterization, Central Venous; Chlorhexidine; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Povidone-Iodine; Prospective Studies

Topics: Aged; Anastomosis, Surgical; Colonoscopy; Colorectal Neoplasms; Humans; Intraoperative Care; Laparoscopy; Male; Neoplasm Recurrence, Local; Neoplasm Seeding; Povidone-Iodine; Rectum; Surgical Stapling; Therapeutic Irrigation

Tumor cells exfoliated into the peritoneal cavity during colorectal cancer surgery are viable and tumorigenic and may contribute to peritoneal recurrence. Although commonly used, the tumoricidal effectiveness of antiseptics in peritoneal lavage is doubted because of their chemical alteration by peritoneal secretions. In contrast, osmotic lysis by incubation in distilled water may offer an effective tumoricidal activity. Data defining the susceptibility of colorectal carcinoma cells to osmotic lysis are lacking and hence there is no consensus on optimal lavage methodology.. We examined the cytocidal activity of water on colorectal cancer cell lines in culture and determined the effect of peritoneal secretions in vivo on the tumoricidal effectiveness of water.. Incubation of cells in distilled water resulted in cell lysis, with 100 percent lysis achieved after 14 minutes of incubation. In vivo, contamination of lavage water by peritoneal secretions produced a resultant solution with an osmolality of 50 mM. Sequential lavages reduced this contamination, enabling a final resultant solution with an osmolality of 10 mM, which produced 100 percent cell lysis after 32 minutes of incubation.. Current peritoneal lavage methodology is inadequate because complete cell lysis requires water incubation for longer time periods than is currently practiced. Solutions to this problem are discussed.

Topics: Anti-Infective Agents, Local; Body Fluids; Cell Count; Cell Culture Techniques; Cell Line, Tumor; Cell Survival; Colorectal Neoplasms; Drug Evaluation, Preclinical; Humans; Intraoperative Care; Linear Models; Neoplasm Seeding; Osmolar Concentration; Osmotic Pressure; Peritoneal Lavage; Peritoneum; Povidone-Iodine; Sodium Chloride; Time Factors; Tumor Cells, Cultured; Water

Rectal irrigation with a cytotoxic agent does not kill viable intraluminal cancer cells proximal to the primary tumour. To prevent implantation of these cells at the time of restorative proctectomy, the feasibility of retrograde whole-colon irrigation just before surgery was explored.. The cytotoxic efficacy of different combinations of povidone-iodine (PVPI) and Gastrografin was tested with the trypan blue exclusion test on a human colon carcinoma cell line (SW620) in vitro. Subsequently, a retrograde whole-colon lavage with PVPI 5 per cent and Gastrografin 12 per cent was performed in 14 euthyroid, non-allergic patients with colorectal cancer using a colostomy irrigation set. Thyroid function and mucosal damage were assessed.. It took 2 min and approximately 1 litre of infused solution to reach the caecum in all patients. The solution was 100 per cent tumoricidal in vitro and remained so after colonic irrigation. Total serum tri-iodothyronine (T3) levels decreased and those of reverse T3 increased, but normalized after 1 week. Superficial epithelial desquamation was observed shortly after irrigation; however, complete restoration occurred within 7 days.. A rectal washout can easily be extended to a retrograde irrigation of the whole colon in elective colorectal cancer surgery. This may help to prevent anastomotic and local recurrence due to implantation of viable exfoliated tumour cells.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Antibiotics, Antineoplastic; Colorectal Neoplasms; Contrast Media; Diatrizoate Meglumine; Dose-Response Relationship, Drug; Feasibility Studies; Female; Humans; Male; Middle Aged; Neoplasm Seeding; Povidone-Iodine; Proctocolectomy, Restorative; Therapeutic Irrigation; Tumor Cells, Cultured

Segmental intraluminal instillation of several tumoricidal agents including povidone-iodine has been advocated to prevent anastomotic recurrence after colonic resection for colorectal cancer. The local and systemic effects of on-table whole-colon washout using 5 per cent povidone-iodine were assessed in patients undergoing elective surgery for colorectal cancer.. The local effect of 5 per cent povidone-iodine on the colonic mucosa and the effect of colonic mucosal damage by povidone-iodine on tumour take was first investigated in Fischer 344 rats. In 12 euthyroid non-allergic patients, on-table whole-colon lavage via the appendix was performed. Systemic (thyroid function) and local (mucosal damage assessed by repeat biopsies) effects were studied, as well as the in vitro tumoricidal effect of the final anal effluent on tumour cell suspensions.. After 30 min of contact with povidone-iodine the rat colonic mucosa was severely injured, with detachment of the epithelial cell layer. Povidone-iodine-induced 'colitis' did not result in tumour development after inoculation of 10(6) Mtln3 carcinoma cells in ten rats. Epithelial desquamation was also observed, in all but one patient, 1 and 4 h after colonic lavage. However, epithelial restitution started within 1 day and no abnormality was revealed after 3-7 days. Urinary iodine excretion increased markedly and was not within normal values after 1 week. Levels of thyroid hormones decreased significantly but became normal within 1 week. The anal effluent containing povidone-iodine was found to be tumoricidal in vitro on a human colonic carcinoma cell line and on a tumour cell suspension produced from the patient's tumour.. On-table whole-colon washout using 5 per cent povidone-iodine seems clinically feasible. This technique deserves further study as a substitute for preoperative bowel preparation and may help to prevent recurrent cancer due to implantation of viable exfoliated tumour cells.

Topics: Adult; Aged; Animals; Anti-Infective Agents, Local; Biopsy; Colorectal Neoplasms; Female; Humans; Intestinal Mucosa; Intraoperative Care; Male; Middle Aged; Povidone-Iodine; Rats; Rats, Inbred F344; Therapeutic Irrigation; Thyroid Diseases; Thyronines; Thyrotropin; Thyroxine-Binding Proteins; Tumor Cells, Cultured

The presence of organic material in the intestinal lumen is reported to interfere with the efficacy of cancericidals when used in low concentrations to prevent anastomotic recurrence in colorectal cancer surgery. We aimed at investigating the efficacy of intra-operative whole-colon washout using povidone-iodine in an experimental model of anastomotic tumour growth. A large inoculum of highly 'tumorigenic' carcinoma cells was instilled in the colonic lumen of Fischer rats. The whole-colon water washout was intended to remove the luminal organic material. This was followed by irrigation of increasing concentrations of povidone-iodine up to 5% with or without additional incubation for 10-20 min. Five animals died after 30 min incubation with povidone-iodine 5%. Tumour take was observed in all control animals including after irrigation with physiological saline. Increasing the povidone-iodine concentration from 1 to 5% reduced the rate of tumour take, but not significantly. The anastomotic tumour growth was significantly reduced after tumour cell inoculation followed by whole-colon lavage and luminal incubation for 20 min with povidone-iodine 5%. Application of intra-operative whole-colon washout to remove the luminal 'organic material' followed by luminal application of povidone-iodine 5% for a sufficient incubation time could reduce the risk of anastomotic recurrence in colorectal cancer surgery.

Topics: Anastomosis, Surgical; Animals; Colorectal Neoplasms; Female; Neoplasm Recurrence, Local; Povidone-Iodine; Rats; Rats, Inbred F344; 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

Implantation of exfoliated tumour cells can give rise to local recurrence of colorectal cancer and it has been recommended that the bowel lumen be lavaged with a tumoricidal agent. This study identified which tumoricidal agents are currently used in Scotland and investigated their efficacy in vitro and in vivo. Cytotoxic efficacy was tested in vitro by a clonogenic assay and in vivo by a rat model with viable intraluminal tumour cells. Overall 70 per cent of surgeons used a tumoricidal agent during colorectal cancer surgery. Povidone-iodine, sodium hypochlorite and chlorhexidine-cetrimide were all effective at killing tumour cells in vitro but were all inactivated by the presence of 25 per cent whole blood in vitro. With 10(5) cells in vivo povidone-iodine and sodium hypochlorite significantly (P < 0.02) reduced the incidence of tumour growth while chlorhexidine-cetrimide had no significant effect. With 10(6) cells povidone-iodine had no effect on the incidence of tumour growth. Tumoricidal agents have effective cytotoxicity in vitro but are only weakly cytotoxic in vivo.

Topics: Animals; Cell Division; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Colorectal Neoplasms; Drug Screening Assays, Antitumor; Female; Neoplasm Recurrence, Local; Povidone-Iodine; Rats; Rats, Inbred F344; Sodium Hypochlorite; Tumor Cells, Cultured