Analysis of postoperative complications associated with the use of anti-adhesion sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier after cytoreductive surgery for ovarian, fallopian tube and peritoneal cancers

The Kelly Gynecologic Oncology Service, Department of Gynecology & Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Gynecologic Oncology (Impact Factor: 3.77). 02/2011; 120(2):220-3. DOI: 10.1016/j.ygyno.2010.10.037
Source: PubMed


To evaluate the risk of postoperative complications related to HA-CMC use in patients undergoing optimal cytoreductive surgery for primary and recurrent ovarian, fallopian tube, and peritoneal cancers.
A single institution retrospective review identified all patients undergoing optimal (≤1 cm) cytoreductive surgery for primary or recurrent ovarian, fallopian tube, and peritoneal cancers between 1/95 and 12/08. Operative details and post-operative complications (<30 days) were extracted from the medical record. Fisher's exact test, Mann-Whitney-U, and multiple regression analyses were performed to identify factors, including HA-CMC use, associated with post-operative complications.
Three hundred seventy-five cases were analyzed: HA-CMC was utilized in 168 debulking procedures. There was no difference in the incidence of overall morbidity for patients with HA-CMC compared to those without HA-CMC (OR 1.07; 95% CI: 0.68-1.67). On univariate analysis, application of HA-CMC increased the risk of pelvic abscess (OR 2.66; 95% CI: 1.21-5.86), particularly in the primary surgery setting (OR 4.65; 95% CI: 1.67-12.98) and in patients undergoing hysterectomy (OR 3.36; 95% CI: 1.18-9.53). After controlling for confounding factors using multiple linear regression, HA-CMC use approached statistical significance in predicting an increased risk of pelvic abscess but not major postoperative morbidity.
HA-CMC adhesion barrier placement at the time of optimal cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancer is not associated with major postoperative complications but may be associated with increased risk of pelvic abscess.

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    • "Its effectiveness in gynecologic surgery was demonstrated by a randomized trial of Seprafilm placement at the time of abdominal uterine myomectomy, which showed an 85% reduction in anterior uterine adhesion formation [4]. More recent data has raised safety concerns regarding the product, with increased rates of bowel anastamosis leak and possibly pelvic abscess [5] [6]. "
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    ABSTRACT: Abstract: We evaluated the use of a carboxymethylcellulose-hyaluronate adhesion barrier (Seprafilm) at the time of Cesarean section, controlling for severity of adhesions in a racially diverse population. This retrospective cohort study included all women who underwent Cesarean section between the years 2006-2010 and returned for a second pelvic surgical procedure at our tertiary care center. All patients who had a Seprafilm barrier placed at the first (index) Cesarean section were matched on a 2:1 basis to those who received no barrier. Effectiveness and surgical outcomes were compared with Chi Square and Wilcoxon tests. Cofounders were identified and controlled with logistic regression models. The main outcome measures were the location and severity of pelvic adhesions at the follow-up pelvic surgery. Seventy-seven women who had Seprafilm placed at the index delivery were matched to 154 controls who received no barrier. The two groups had similar rates of any dense adhesions (43% and 42% respectively, P=.78) and adhesions on the anterior uterus (34% and 31%, P=.62) at follow-up. After controlling for all significant confounders, adhesion barrier use did not show a significant decrease in any adhesion formation (aOR=0.79, 95% CI, 0.43-1.45) or anterior uterine dense adhesion formation (aOR=0.88, 95% CI, 0.46-1.65). There were no significant differences in delivery times at follow-up (median 11 minutes in each group, P=.54), or in rate of pelvic infection at the index surgery (5% in each group, P=1.0). Seprafilm use at Cesarean section was not associated with a significant decrease in dense adhesion formation, operative complications, or delivery time.
    Full-text · Article · Jul 2015
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    • "Only one is prospective including 14 patients with HA-CMC barrier, and concern in half of the cases cervical and uterine cancers. Krill et al. evaluated the risk of postoperative complications related to HA-CMC utilization in ovarian cancers after cytoreductive surgery and showed that this biomaterial is not responsible for major complications but may be associated with increased risk of pelvic abscess [30]. However, they did not study the effects of HA-CMC on ovarian cancer progression and recurrence. "
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    ABSTRACT: Hyaluronic acid is a prognostic factor in ovarian cancers. It is also a component of Hyaluronic Acid-Carboxymethyl Cellulose (HA-CMC) barrier, an anti-adhesion membrane widely used during abdominal surgeries in particular for ovarian carcinosis. 70% of patients who undergo ovarian surgery will relapse due to the persistence of cancer cells. This study's objective was to determine the oncological risk from use of this material, in the presence of residual disease, despite the benefit gained by it decreasing post-surgical adhesions in order to provide an unambiguous assessment of its appropriateness for use in ovarian surgical management. We assessed the effects of HA-CMC barrier on the in vitro proliferation of human ovarian tumor cell lines (OVCAR-3, IGROV-1 and SKOV-3). We next evaluated, in vivo in nude mice, the capacity of this biomaterial to regulate the tumor progression of subcutaneous and intraperitoneal models of ovarian tumor xenografts. We showed that HA-CMC barrier does not increase in vitro proliferation of ovarian cancer cell lines compared to control. In vivo, HA-CMC barrier presence with subcutaneous xenografts induced neither an increase in tumor volume nor cell proliferation (Ki67 and mitotic index). With the exception of an increased murine carcinosis score in peritoneum, the presence of HA-CMC barrier with intraperitoneal xenografts modified neither macro nor microscopic tumor growth. Finally, protein analysis of survival (Akt), proliferation (ERK) and adhesion (FAK) pathways highlighted no activation on the xenografts imputable to HA-CMC barrier. For the most part, our results support the lack of tumor progression activation due to HA-CMC barrier. We conclude that the benefits gained from using HA-CMC barrier membrane during ovarian cancer surgeries seem to outweigh the potential oncological risks.
    Full-text · Article · Apr 2014 · Journal of Ovarian Research
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    • "Adhesion barrier devices that are used to separate tissue surfaces and prevent adhesions are an increasingly accepted adjunct to abdominopelvic surgery. Many studies have shown the antiadhesive effect of HA-CMC in animal models, human abdominal surgery, human facial surgery, human esophageal surgery, human breast surgery and human craniotomy [15-22]. Among them, there were interesting studies on a novel antiadhesive film based on cross-linked carboxymethylcellulose and atorvastatin, with that of sodium hyaluronate-carboxymethylcellulose [23,24]. "
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    ABSTRACT: A number of researchers have suggested the use of sodium hyaluronate carboxymethyl cellulose (HA-CMC) membrane for preventing postoperative adhesion. This study evaluated the antiadhesive effect and safety of HA-CMC membrane in thyroidectomy for papillary thyroid cancer. One hundred sixty-two patients who underwent thyroidectomy were prospectively randomized. In the study group of 80 patients, the 7.5 cm × 13 cm HA-CMC membrane was applied to the operative field after thyroidectomy. The subjects were asked about complications including adhesive symptoms using an 8-item questionnaire at 2 weeks, 3 months, and 6 months after surgery. In addition, items on the appearance of neck wrinkles and scars were evaluated by a physician who had no information about the patient's allocation. There were no significant differences in complications such as swallowing difficulty, and wrinkles between study and control groups. Both groups presented significantly decreased scores over time in swallowing difficulty, and wrinkles. There were no complications regarding the HA-CMC membrane. The antiadhesive effect of HA-CMC membrane in thyroid surgery is still uncertain, although it is biologically safe. Further investigation is needed to confirm the antiadhesive effect of HA-CMC membrane in thyroid surgery.
    Full-text · Article · Nov 2013 · Journal of the Korean Surgical Society
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