Impact of diagnostic peritoneal lavage on omentum metastasis

项目摘要/摘要 大网膜是一种富含免疫细胞的脂肪组织，悬挂在胃中，在 腹膜防御。大网膜是卵巢癌转移的主要部位，转移到卵巢癌 大网膜可导致致命的肠梗阻。尽管手术切除大网膜一直被提倡 对于没有明显大网膜转移的癌症患者，这一预防性程序已被 争论不休。这项研究的总体目标是找出将预兆风险降至最低的方法。 大网膜保存时，隐匿性循环癌细胞的转移。腹膜灌洗是一种诊断 作为腹部癌症分期的一部分而进行的一种手术，在此过程中将生理盐水注入 对腹膜腔和冲洗液进行细胞学检查。盐水也被广泛使用 用于静脉注射。补充液体和电解质。在重症监护环境中输液的研究表明 生理盐水的主要不良反应是高氯酸中毒，有证据表明酸中毒可以 激活炎症反应，从而形成允许癌症的环境。因为大网膜有巨大的 吸收腹膜内液体的能力，我们推测大网膜可能是有害的。 受生理盐水腹腔灌洗的影响。根据这些先前的报告和我们的初步研究，我们 假设用生理盐水灌洗腹膜能刺激大网膜变得有利于 植入隐匿性癌细胞。在这项研究中，我们将评估生理盐水对腹膜灌洗的影响。 大网膜的细胞成分和炎症反应的溶液，并确定这是否 灌洗刺激小鼠同种异体卵巢移植模型大网膜种植循环癌细胞 癌症。重要的是，我们还将确定是否可以通过使用 用缓冲溶液代替生理盐水进行腹膜灌洗。如果成功，我们的研究将提供一个新的和 修订诊断和分期做法以减少转移到 当这个部位被保存时的大网膜。

PROJECT SUMMARY/ABSTRACT The omentum is an immune cell-rich fatty tissue that suspends from the stomach and plays an important role in peritoneal defense. The omentum is the predominant site of ovarian cancer metastasis, and metastasis to the omentum can lead to fatal bowel obstruction. Although surgical removal of the omentum has been advocated for cancer patients who do not present with overt omental metastasis, this prophylactic procedure has been contentious. The over-arching goal of this study is to identify approaches to minimize the risk of omental metastasis by occult circulating cancer cells when the omentum is preserved. Peritoneal lavage is a diagnostic procedure that is performed as part of abdominal cancer staging in which saline solution is administered into the peritoneal cavity and the washings are cytologically examined. Saline solution has also been widely used for i.v. fluid and electrolyte replenishment. Studies of infusion in the critical care setting have shown that the main adverse effect of saline solution is hyperchloremic acidosis, and there is evidence that acidosis can activate inflammatory responses that foster a cancer-permissive milieu. Because the omentum has immense capability to absorb fluid in the peritoneal cavity, we speculate that the omentum might be deleteriously affected by peritoneal lavage with saline solution. Based on these prior reports and our preliminary studies, we hypothesize that peritoneal lavage with saline solution stimulates the omentum to become conducive for implantation of occult cancer cells. In this study, we will evaluate the impact of peritoneal lavage with saline solution on cellular constituents of the omentum and inflammatory responses, and determine whether this lavage stimulates implantation of circulating cancer cells on the omentum in mouse allograft models of ovarian cancer. Importantly, we will also determine whether the risk of omental metastasis can be minimized by using buffered solutions instead of saline for peritoneal lavage. If successful, our study will provide a new and important rationale for revising diagnostic and staging practices to reduce the risk of metastasis to the omentum when this site is preserved.