Effect of preoperative irradiation on healing of low colorectal anastomoses

Morgenstern, Leon; Sanders, George B.; Wahlström, Erik; Yadegar, Joseph; Amodeo, Pamela

doi:10.1016/0002-9610(84)90099-0

Cited by 35 publications

(20 citation statements)

References 11 publications

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“…Histologic findings such as edema, vascular congestion, microscopic ulcerations, and areas of hemorrhage were found in all animals on the 7th day. Similar abnormalities were also reported by other investigators (20)(21)(22)24,25,(32)(33)(34)(35)(36). The thickening and hyalinization of the arterial walls reported in other experimental studies (19,22,36) were not observed in the present study, possibly due to the lower dose of irradiation employed by us.…”

Section: Discussionsupporting

confidence: 91%

“…There was no leakage in the present study, but experimental studies using higher doses have shown leakage rates ranging from 20 to 80% (21,22,25,26). Although bursting pressure is not the most accurate assessment, it is closer to the physiologic condition of leakage by increasing the intra-luminal pressure than the breaking strength assessment.…”

Section: Discussioncontrasting

confidence: 60%

“…However, there are still concerns about the healing of rectal anastomoses (17), which had led Minsky et al (18) to recommend a diverting stoma. Conflicting results were also reported in experimental studies using high and moderate doses of irradiation (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Heupel et al (19) and Crowley et al (20) reported a good outcome of colon and small bowel anastomoses, respectively, using a single 500-cGy preoperative dose of irradiation in dogs.…”

Section: Introductionmentioning

confidence: 99%

“…2000 and 6000 cGy, have been related to anastomosis failure, ranging from 20 to 80% in experimental models (21)(22)(23)(24)(25). However, Meese et al (26) demonstrated that late effects of irradiation do not preclude the safe construction of low anterior anastomoses using 4000 and 5000 cGy preoperative irradiation doses in dogs.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative cobalt60 irradiation delays the healing of rectal anastomoses in rats

Chen

Klug

Capelhuchnik

2005

Braz J Med Biol Res

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The healing of colorectal anastomoses after irradiation therapy continues to be a major concern. The authors evaluated the healing of rectal anastomoses in a rat model after a preoperative 500-cGy dose of cobalt 60 irradiation. Thirty-six male Wistar rats were divided into two equal groups: control (group A), and irradiation group (group B). Group B received a single 500-cGy dose of irradiation, and a rectal resection and end-to-end anastomosis was performed in both groups on the 7th day after irradiation. Parameters of the healing process included bursting pressure and collagen content on the 5th, 7th, and 14th days after surgery. In the irradiation group, the mean bursting pressure on the 5th, 7th, and 14th days was 116, 218, and 273 mmHg, respectively. The collagen content assessed by histomorphometry was 9.0, 20.8, and 32%, respectively. In contrast, the control group had a mean bursting pressure of 175, 225 and 263 mmHg, and a collagen content of 17.8, 28.1, and 32.1%, respectively. The adverse effect of irradiation on healing was detectable only on the 5th postoperative day, as demonstrated by lower bursting pressure (P < 0.013) and collagen content (P < 0.008). However, there was no failure of anastomotic healing such as leakage or dehiscence due to irradiation. We conclude that a single preoperative 500-cGy dose of irradiation delays the healing of rectal anastomosis in rats.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative cobalt60 irradiation delays the healing of rectal anastomoses in rats

Chen

Klug

Capelhuchnik

2005

Braz J Med Biol Res

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“…El-Malt et al 31 reported that preoperative CRT had no harmful effect on the mechanical strength of colonic anastomosis. Besides the studies defending that RT has negative effects on anastomosis healing, 5,32,33 there are also studies [34][35][36] reporting that RT does not impair wound healing. Various outcomes have been reported in the studies investigating the effects of 5-FU on wound healing.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Hyperbaric Oxygen Therapy on Experimental Colon Anastomosis After Preoperative Chemoradiotherapy

Yıldız¹,

Can²,

Yağcı³

et al. 2013

International Surgery

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The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female WistarAlbino rats were divided into 5 groups and underwent left colon resection and end-toend anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.Key words: Anastomosis -Chemoradiotherapy -Hyperbaric oxygen -Rat -Burst pressure 2 Although adjuvant therapy has been a well-accepted procedure to prevent metastasis and local recurrence after surgical resection, more recently neoadjuvant therapy has gained popularity to enable secondary curative resection with clear surgical margin and to prolong overall and recurrence-free survival.2 It has been reported that local recurrence rate is lower, toxicity is rare, and the anal sphincter is more likely to be preserved in those undergoing preoperative radiation. 1,2Despite the current advances in surgical techniques, anastomotic leakage is a severe complication leading to morbidity and mortality after intestinal surgery.3-6 Chemoradiotherapy (CRT) has the potential to lead to inadequate vascularization in tissues, a well-known risk factor for intestinal anastomosis leak. Impaired oxygenation as a result of hampered vascularization may lead to delay in wound healing, which ultimately impairs anastomotic durability. Studies on factors that enhance wound healing to prevent anastomotic leakage in colon anastomosis have been accelerated in the past decade. In a limited number of studies performed for this purpose, hyperbaric oxygen therapy (HBOT), which is applied by means of intermittent inhalation of 100% oxygen under 1 atmosphere pressure, has been reported to have favorable effects on intestinal anastomotic healing.7-9 However, whether HBOT can reverse potential side effects of CRT on would healing and anastomotic durability is unclear. The aim of the present study was to investigate the effects of HBOT on the bioche...

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Preoperative short-term radiotherapy in rectal carcinoma. A preliminary report of a prospective randomized study

Cedermark

Theve

Rieger

et al. 1985

Cancer

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Between 1980 and 1983, 373 patients with clinically resectable rectal adenocarcinoma entered a prospective randomized study aimed to evaluate the effect of short‐term preoperative radiotherapy. Protocol violations were identified in 21 instances. Of the remaining 352 patients, 182 were randomized to surgical treatment only (S‐group). Immediately, before surgery, 170 patients were irradiated to the pelvic region with 25 Gy (2500 rad) during a 5‐day period (RT‐group). Of these patients, 59% underwent abdominoperineal excision, 38% anterior resection, and 3% laparotomy only. At surgery distant metastases were discovered in 32 patients (9%). There were no significant differences between the groups in the distribution of age, sex, operative methods, and tumor stage according to the original Dukes' classification. During the follow‐up time, ranging between 6 months and 3 years, tumor recurrence occurred in 35 patients, 19 in the S‐group and 16 in the RT‐group. Fifteen patients in the S‐group had pelvic recurrence compared to 10 patients in the RT‐group. Distant metastases occurred in six and eight patients, respectively. Two patients in each group had both pelvic and distant recurrence. There was no correlation between tumor recurrence and type of operation. Median time interval from diagnosis to pelvic recurrence was 10 months in the S‐group and 16 months in the RT‐group. Postoperative complications in the form of wound sepsis were slightly more common in the RT‐group. In summary, the applied treatment regimen, is well‐tolerated and apparently does not affect the Dukes' stage of the tumor. Although there is no statistically significant difference, there is a trend of less pelvic recurrence in patients receiving preoperative radiotherapy. Cancer 55:1182‐1185, 1985.

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Effect of preoperative irradiation on healing of low colorectal anastomoses

Cited by 35 publications

References 11 publications

Preoperative cobalt60 irradiation delays the healing of rectal anastomoses in rats

Preoperative cobalt60 irradiation delays the healing of rectal anastomoses in rats

The Effects of Hyperbaric Oxygen Therapy on Experimental Colon Anastomosis After Preoperative Chemoradiotherapy

Preoperative short-term radiotherapy in rectal carcinoma. A preliminary report of a prospective randomized study

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