sodium-hypochlorite and Colorectal-Neoplasms

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

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