Effects of Preoperative Conventional and Hyperfractionated Radiotherapy on the Healing of Rat Colonic Anastomoses

Abstract

Background: One problem associated with end to end anastomoses after preoperative radiotherapy is leakage. The strength of the anastomoses is very important. Fractionation schedules are widely under investigation to achieve higher doses with less toxicity and high curative potential. The aim of this study was to compare preoperative conventional and hyperfractionated radiotherapy effects on anastomoses. Materials and Methods: Sixty Wistar albino rats were divided into 3 groups: control, conventional radiotherapy (2 Gy/fraction, total 44 Gy), and hyperfractionated radiotherapy (1.2 Gy/fraction, total 52.8 Gy). 5 weeks after completion of the treatment, the rats underwent end to end anastomoses to the rectum. Following the surgery, the bursting pressure of the anastomoses and the hydroxyproline levels were measured on days 3 and 7. Results: The bursting pressure was lower in both radiotherapy groups on the 3rd day. On day 7, the results of the conventional radiotherapy arm matched those of the control group, but the results of the hyperfractionated group did not (p = 0.001). On day 3, hydroxyproline levels were significantly lower in both radiotherapy groups than in the control group (p = 0.001). On the 7th day, the statistical difference disappeared within the radiotherapy groups. However, the hydroxyproline levels of the 2 radiotherapy arms were still lower than those of the control group (p = 0.001). Conclusion: Hyperfractionation strongly inhibits collagen synthesis and is associated with protracted healing.

The effect of pasireotide on intestinal anastomotic healing with and without whole-body irradiation in a rat model

“…The anastomotic healing process is not as widely exposed to the action of pancreatic enzymes as is the case in diffuse irradiation injury. However, patients who receive neoadjuvant irradiation bear a considerably higher risk for postoperative anastomotic leakage than patients who do not [ 10 , 17 ]. This is often ensued by complicated and protracted postoperative courses with development of pelvic abscesses, fistulas, and peritonitis.…”

“…Irradiation causes substantial gastro-intestinal toxicity and is known to have a detrimental effect on the vulnerable process of anastomotic healing. This can be quantified using various quality parameters of healing (e.g., bursting pressure, collagen density, histology, and leakage rate), thus rendering the anastomosis far more instable [ 3 , 7 , 10 , 17 , 19 , 26 ].…”

Effects of radiation therapy on postoperative complications and adverse events in patients with head and neck reconstruction with flaps

“…Mourad et al reported that radiation therapy significantly increased the duration of heterotopic ossification. In addition, the soft tissues of the fistula do not tend to adhere together, and the localization of abscess is difficult to clarify, permitting infection to spread and necessitating additional surgery . Blood flow through tissues is decreased in the radiation field, and spontaneous healing is also delayed.…”