Impact of diagnostic peritoneal lavage on omentum metastasis

项目总结/摘要 网膜是一种富含免疫细胞的脂肪组织，从胃中悬浮出来，在 腹膜防御大网膜是卵巢癌转移的主要部位，并且转移到大网膜是卵巢癌的主要转移部位。 大网膜会导致致命的肠梗阻虽然手术切除大网膜已被提倡 对于不存在明显网膜转移的癌症患者， 有争议本研究的主要目的是确定最大限度地减少网膜炎风险的方法。 当保留网膜时，通过隐匿的循环癌细胞转移。腹腔灌洗是诊断 作为腹部癌症分期的一部分进行的程序，其中将盐水溶液施用到 对腹膜腔和冲洗液进行细胞学检查。盐水溶液也被广泛使用 用于静脉输液和电解质补充重症监护环境中的输液研究表明， 盐溶液的主要不良反应是高尿酸性酸中毒，有证据表明酸中毒可 激活炎症反应，形成癌症环境。因为网膜有巨大的 由于腹膜腔吸收液体的能力，我们推测网膜可能是恶性的， 受到盐水溶液腹腔灌洗的影响。根据这些先前的报告和我们的初步研究，我们 假设用盐水溶液进行腹膜灌洗刺激网膜变得有利于 隐藏的癌细胞的植入。在这项研究中，我们将评估用生理盐水腹腔灌洗的影响， 溶液对网膜细胞成分和炎症反应的影响，并确定这是否 灌洗刺激循环癌细胞在小鼠卵巢移植模型网膜上的种植 癌重要的是，我们还将确定是否可以通过使用 用缓冲溶液代替盐水进行腹膜灌洗。如果成功，我们的研究将提供一个新的， 修改诊断和分期实践以降低转移到 当这个位置被保留时，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.