The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model

Abstract

Introduction Cytoreductive surgery (CRS) with subsequent hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising modality to treat and prevent peritoneal metastases. However, this treatment is associated with signficant morbidity and mortality. Whether or not CRS with HIPEC interferes with anastomotic healing has also been debated. This study was designed to investigate the effects of mitomycin C, cisplatin, oxaliplatin, and doxorubicin used in HIPEC treatment on colonic anastomosis healing in a rat model. Methods Sixty Wistar albino rats were employed in the study. Sigmoid resection and end-to-end colorectal anastomosis was performed in all rats. Group 1 rats underwent the surgical procedure alone, while group 2 rats were given hyperthermic intraperitoneal lavage with heated saline following surgery. Groups 3, 4, 5, and 6 had surgery with concomitant HIPEC treatment with mitomycin C, cisplatin, oxaliplatin, and doxorubicin, respectively. Anastomotic bursting pressures and hydroxyproline levels were evaluated. Results Regarding the hydroxyproline levels, groups 1 and 2 showed significantly higher values than other groups (p<0.001). However, there was no significant difference between the HIPEC treatment groups (groups 3, 4, 5, and 6) (p>0.05). When groups were compared regarding bursting pressure values, no significant differences were observed (p = 0.81). Conclusions This study demonstrated that the HIPEC procedure with mitomycin C, cisplatin, oxaliplatin and doxorubicin had negative effects on hydroxyproline levels, but had no detrimental effect on anastomotic bursting pressure in a rat model.

The effects of platelet‐rich‐plasma gel application to the colonic anastomosis in hyperthermic intraperitoneal chemotherapy: An experimental rat model

“…3,[16][17][18][19][20][21][22] Experimental studies have shown that intraperitoneal chemotherapy has a negative impact on anastomosis healing by the cytostatic effect, which reduces angiogenesis and collagen formation. 3,4,23,24 In our study, the anastomosis bursting pressure and hydroxyproline levels were significantly lower in the HIPEC group and these findings were similar to previous reports. 3,4 It was formerly thought that platelets have only haemostatic activity, but recent studies have shown that platelets play a critical role in inflammation by producing various growth factors and cytokines.…”

“…3,4,23,24 In our study, the anastomosis bursting pressure and hydroxyproline levels were significantly lower in the HIPEC group and these findings were similar to previous reports. 3,4 It was formerly thought that platelets have only haemostatic activity, but recent studies have shown that platelets play a critical role in inflammation by producing various growth factors and cytokines. 8 Numerous experimental studies have shown that applying PRP on intestinal anastomosis resulted in improved anastomosis healing.…”

“…Experimental studies have shown that intraperitoneal chemotherapy has a negative impact on anastomosis healing by the cytostatic effect, which reduces angiogenesis and collagen formation . In our study, the anastomosis bursting pressure and hydroxyproline levels were significantly lower in the HIPEC group and these findings were similar to previous reports …”

“…Both experimental and clinical studies show that HIPEC has negative effects on anastomotic healing. Surgeons may prefer either ileostomy or colostomy to prevent abdominal sepsis because of anastomosis leakage (AL), which results in the reduction of patients' quality of life, increased mortality, and morbidity …”

“…Surgeons may prefer either ileostomy or colostomy to prevent abdominal sepsis because of anastomosis leakage (AL), which results in the reduction of patients' quality of life, increased mortality, and morbidity. [3][4][5][6][7] Platelet-rich-plasma (PRP) is an autologue platelet concentrate that contains numerous platelet-derived growth factors. Since the early 1980s, it has been widely used in different areas for its positive impact on the wound healing.…”