Impact of diagnostic peritoneal lavage on omentum metastasis

诊断性腹腔灌洗对大网膜转移的影响

• 批准号: 10286303
• 负责人: Honami Naora
• 金额: $ 8.1万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-08 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10286303
• 关键词: Acidosis; Address; Adipose tissue; Adverse effects; Advocate; Affect; Allografting; Blood Vessels; Body Fluids; Buffers; Cancer Biology; Cancer Patient; Cells; Cellular Structures; Chlorides; Clinical; Clinical Trials; Critical Care; Cytology; Diagnosis; Diagnostic; Diagnostic Neoplasm Staging; Diagnostic Procedure; Dose; Drainage procedure; Electrolytes; Excision; Fostering; Goals; Greater sac of peritoneum; Growth; Growth Factor; Immune; Implant; Inflammatory; Inflammatory Response; Infusion procedures; Intestinal Obstruction; Irrigation; Lactated Ringer' s Solution; Lead; Liquid substance; Literature; Malignant Neoplasms; Malignant neoplasm of abdomen; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of ovary; Modeling; Mus; NOS2A gene; Neoplasm Metastasis; Normal saline; Omentum; Osmolalities; Pain; Peritoneal; Peritoneal lavage; Physiological; Play; Prevention; Procedures; Property; Publishing; Reporting; Risk; Role; Saline; Site; Sodium; Sodium Chloride; Spottings; Staging; Stomach; Time; angiogenesis; base; cancer cell; circulating cancer cell; clinically relevant; cost effective; density; experience; implantation; improved; in vivo; innovation; preservation; prevent; prophylactic; response; risk minimization; tumor

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.

项目概要/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，转移至 大网膜可导致致命性肠梗阻。尽管提倡手术切除大网膜 对于没有明显网膜转移的癌症患者，这种预防性手术已被采用 有争议的。本研究的首要目标是确定最大限度降低网膜风险的方法 当大网膜被保留时，隐匿性循环癌细胞会发生转移。腹腔灌洗是一种诊断方法 作为腹部癌症分期的一部分进行的程序，其中将盐溶液注入 对腹膜腔和冲洗液进行细胞学检查。盐溶液也被广泛使用 用于静脉注射补充液体和电解质。对重症监护环境中输液的研究表明， 盐水溶液的主要不良反应是高氯性酸中毒，有证据表明酸中毒可以 激活炎症反应，形成有利于癌症的环境。因为大网膜有巨大的 吸收腹膜腔液体的能力，我们推测大网膜可能是有害的 受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腔灌洗会刺激大网膜，使其有利于 隐匿性癌细胞的植入。在本研究中，我们将评估盐水腹腔灌洗的影响 解决方案对大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同种异体移植模型的大网膜上植入 癌症。重要的是，我们还将确定是否可以通过使用 使用缓冲溶液代替盐水进行腹腔灌洗。如果成功的话，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风险的重要理由 保留该部位时的大网膜。