How long does it take to reduce the risk of spillage TCC implantation by distilled water peritoneal irrigation to complete cytolysis?

Abstract

Objective : Tumor cells spillage from bladder during radical cystectomy increases the risks of seeding in the peritoneum. The current therapy is irrigation with sterile water as rare of strong supportive investigation and unknown extent of clinical benefit. We investigated rate of tumor cell survival after cells immerge in normal saline compare to distilled water. Additionally, we studied in time for near complete osmolytic cytolysis effect of tumor cells.

Study design : Repeated Measures design

Setting : Department of Urology and Department of Pathology, King Chulalongkorn Memorial Hospital

Materail and Methods : Seventy - six specimens from 9 patients who underwent to perform radical cystectomy due to invasive TCC of bladder and bladder biopsy of recurrent TCC were recruited to the study. The subjects were recruited from August 2008 to January 2009. Multiple small pieces of tumor from 9 patients (6-12 specimens per patient) were separated to immerge and oscillate in NSS and distilled water for 5 min, 10 min and 15 min, respectively. Then each treated sample was sent for cytological reports (8 - 20 fields/ slide) from one pathologist to report tumor survival rate. Additionally, we investigated the rate of tumor cytolysis in every 2.5 minute after the specimens were immerged in distilled water for 15 minute from 2 patients.

Results : Distilled water irrigation showed significant decrease the rate of tumor cells survival (p < 0.001). After 15 minutes, most cell viability decreased to approximately 20%.

Conclusion : Intraperitoneal distilled water irrigation after radical cystectomy decrease TCC viable cell spillage cells and it is assumed to decrease the rate of intraperitoneal spillage tumor implantation. Peritoneal irrigation with sterile water for at least 15 minutes after radical cystectomy for 15 minutes decreases spillage survival tumor to approximately 20%.