Experimental carcinogenesis at sutured and sutureless colonic anastomoses

McCue, J. L.; Sheffield, J. P.; Uff, C. R.; Rw, Phillips

doi:10.1007/bf02047881

Cited by 21 publications

(19 citation statements)

References 23 publications

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“…The present study thus corroborates the findings of McCue et al [3] and O'Donell el al. [4] pointing to the importance of the inter action of sutures with the mucosa in tumour formation, and in addition confirms the role of colonic crypt cell proliferation in carcino genesis.…”

Section: Discussionsupporting

confidence: 83%

“…More and more evidence is now accumu lating that sutures themselves may enhance tumour formation at an anastomosis, over and above that caused by the healing wound itself [3,4], Classical experiments by Pozharisski [23] have shown that the chronic, irri tating effect of suture material caused en hanced tumour formation in the caecum after the administration of dimethylhydrazine, a chemical carcinogen. Calderisi and Freeman [24] implanted various sorts of suture mate rial without creating an actual anastomosis and also noted an enhanced tumour yield at the site at which non-absorbed or slowly ab sorbed suture material had been implanted.…”

Section: Discussionmentioning

confidence: 99%

“…I n the experi ments of McGregor et al [ 14] the simple transmural implantation of suture ma terial in the colon of rats which were given azoxymethane resulted in a tumour yield comparable to that in rats in which a classic anastomosis had been carried out. McCue [3] showed that after the administration of azoxy- 218 Hubens/Totté/Verhulst/Van Marek/ Hubens…”

Section: Discussionmentioning

confidence: 99%

“…However, other mechanisms may be responsible for the development of anastomotic recurrence: im plantation of viable, exfoliated colon carci noma cells at the suture line and metachronous carcinogenesis in those recurrences occurring 2 or more years after the primary intervention [1], In metachronous carcinogenesis, the in tensity of cell proliferation at the suture line seems to be the crucial determinant of the risk of malignant change in the epithelium [2], Evidence is accumulating that sutures themselves can enhance tumour formation at an anastomosis over and above that caused by wound healing itself [3,4], In a study on the effect of suture material on colonic anasto motic crypt cell proliferation rate (CCPR) in the rat, we showed that the CCPR of an 8-week-old anastomosis was significantly ele vated when non-absorbable steel suture mate rial was used, whereas no rise in CCPR could be detected when the anastomosis had been carried out with rapidly absorbable suture material (Vicryl Rapide®) [5], In order to explore the respective roles of wound healing and suture material on meta chronous carcinogenesis, we studied the tu mour yield at colonic anastomoses after ad ministration of a chemical carcinogen (azoxymethane) at the moment that in one group of rats suture material was still present and the crypt cell proliferation elevated, while in another group no more suture material was present and the crypt cell proliferation rate normalized at the anastomotic site. As the right and left colon are known to react differ ently to carcinogenic stimuli in both man and animals, the colonic anastomoses were car ried out simultaneously in both the right and left colon of the same animal [6.…”

Section: Introductionmentioning

confidence: 99%

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The Influence of the Interaction of Sutures with the Mucosa on Tumour Formation at Colonic Anastomoses in Rats

Hubens

Totté²,

Verhulst³

et al. 1993

Eur Surg Res

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In order to explore the respective role of wound healing and suture material on metachronous carcinogenesis at colonic lines in rats, tumour yield was studied after the administration of a chemical carcinogen (azoxymethane) at the moment that in one group of rats most of the suture material was still present and crypt cell proliferation elevated, while in another group, no more suture material was present and crypt cell proliferation rate (CCPR) normalized at the anastomotic site. Azoxymethane (15 mg/kg/week, s.c, during 6 weeks) was administered in male Sprague-Dawley rats (n = 105) 8 weeks after the creation of an anastomosis in the ascending and descending colon with either stainless steel sutures (group A, n = 30) or fast-absorption Vicryl (Vicryl Rapide®, group B, n = 30). A control group (group C, n = 30) underwent a sham laparotomy before the administration of azoxymethane, while the animals of a fourth group (group D, n = 15) were not operated upon and received no azoxymethane. Twenty-six weeks after the first injection of azoxymethane there was no significant difference in the total colo-rectal tumour yield in the three operated groups (A, B, C), but a significantly greater proportion of anastomotic tumours (28/68 vs. 13/88, p < 0.01)and more anastomotic tumours per rat (28/23 vs. 13/28, p = 0.01) as well as more rats with anastomotic tumours (16/23 vs. 11/28, p = 0.04) were found in the steel-sutured group (A), compared with the control group (C). No significant differences were observed in tumour distribution between the groups in which the anastomoses were carried out with Vicryl Rapide (B) and the control group (C). Thirty-six weeks after operation steel sutures were recovered in 30.4% (7/23) of the left-sided anastomoses and in only 8.7% (2/23) of the right-sided anastomoses. At that time, CCPR was significantly elevated in the left-sided anastomoses only, while the CCPR in the right-sided anastomoses was normal when compared with all the other groups (A, B, C and D). The present study showed a shift in the distribution of tumours towards the anastomotic sites at which suture material was present and the CCPR raised, at the moment of carcinogen administration, confirming the importance of the interaction of sutures with the mucosa in tumour formation. The actual elimination process of the suture material might influence the CCPR and act as a cocarcinogenic factor. In view of these observations, either the use of strictly inert suture material or the development of sutureless anastomotic techniques should be encouraged in the construction of colonic anastomoses.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Influence of the Interaction of Sutures with the Mucosa on Tumour Formation at Colonic Anastomoses in Rats

Hubens

Totté²,

Verhulst³

et al. 1993

Eur Surg Res

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“…[8][9][10] The different characteristics of the suture materials used for colorectal anastomosis may also predispose to local recurrences. 1,11,12 Various methods have been used for restoring continuity after curative resection of colorectal cancers. Examples reported clinically over the last 10 years include the biofragmentable anastomotic ring, 13-17 the AKA2 (and AKA4) compression device, 18,19 and a series of polypropylene buttons 20 as well as the creation of manual anastomosis using different suture materials, and stapled anastomosis.…”

mentioning

confidence: 99%

The Impact of Various Suture Materials on Experimental Colorectal Carcinogenesis

et al. 2001

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Local tumor recurrence following restorative surgery for colorectal cancer may occasionally result from the promotion of a neoplastic lesion in a zone of proliferative instability adjacent to the anastomosis. This study was designed to determine the influence of various suture materials on experimental colorectal carcinogenesis. A total of 72 rats were divided into six groups, four of which were subjected to colotomy and repair using catgut, silk, polyglactin (PG), or stainless steel. The fifth group was given a sham procedure and the sixth group served as a control. Methylnitrosourea was administered rectally to all the animals, at a dose of 4 mg/kg/week for 20 weeks. The mean number of tumors per rat was significantly higher in the PG group than in the other groups. The mean tumor size was found to be significantly larger in each of the suture material groups than in the sham group. A tendency for tumor occurrence to develop at the anastomosis rather than at the other colon sites was seen in the PG group. These results indicate that PG has an adverse effect on local tumor occurrence in experimental colorectal carcinogenesis.

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Experimental oesophagogastric anastomosis: Preliminary report of a new compression device that also fragments

Rebuffat

Rosati

Fumagalli

et al. 1996

British Journal of Surgery

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Fifteen Beagle dogs underwent oesophagogastric anastomosis with a new device which enables a 'sutureless' compression anastomosis. The device fragmented and was passed in bits anally without causing obstruction. Immediate bursting pressure, tested in five dogs, was between 175 and 190 mmHg. The anastomoses of the remaining dogs were examined macroscopically and microscopically from day 6 to day 30. Healing was excellent with good muscular apposition and minimal residual inflammation.

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Experimental carcinogenesis at sutured and sutureless colonic anastomoses

Cited by 21 publications

References 23 publications

The Influence of the Interaction of Sutures with the Mucosa on Tumour Formation at Colonic Anastomoses in Rats

The Influence of the Interaction of Sutures with the Mucosa on Tumour Formation at Colonic Anastomoses in Rats

The Impact of Various Suture Materials on Experimental Colorectal Carcinogenesis

Experimental oesophagogastric anastomosis: Preliminary report of a new compression device that also fragments

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