Bioresorbable Membrane Composed of Sodium Hyaluronate and Carboxymethylcellulose (Seprafilm) Prevents Cancer Implantation at Peritoneal Defects in 3D-Peritoneum and Murine Models

Background/Aim: The peritoneum is one of the most frequent sites of post-operative recurrence in advanced gastric cancer (GC). Peritoneal defects from laparotomy and GC resection facilitate the implantation of cancer cells shed from the primary tumor into the abdominal cavity. Sodium hyaluronate and carboxymethylcellulose film (Seprafilm) was developed for the purpose of reducing the incidence of postoperative adhesions between the abdominal wall and the underlying visceral organs in patients undergoing abdominal or pelvic surgery. However, it is unknown whether Seprafilm can help prevent cancer cell implantation in peritoneal defects. Materials and Methods: The protective effects of Seprafilm against implantation of GC cells (NUGC4 and T3-2D) in peritoneal defects were evaluated in three-dimensional biomimetic peritoneum and murine models. Results: In the constructed biomimetic peritoneum model, adhesion of cancer cells was significantly inhibited by a mesothelial monolayer compared to without the layer. Inhibition of cancer cell adhesion was significantly greater with Seprafilm than with the mesothelial monolayer. In the murine model, 1 cm² peritoneal defects were created in the abdominal wall, and cancer cells were injected into the abdominal cavity. Cancer cell implantation volume was significantly lower in peritoneal defects with Seprafilm than in those without Seprafilm. Histologically, Seprafilm resolved within 7 days. Conclusion: Seprafilm may contribute to reducing postoperative peritoneal recurrence at the dissection site in addition to reducing postoperative adhesion.