Healing of experimental colonic anastomoses: Effects of combined preoperative high‐dose radiotherapy and intraperitoneal 5‐fluorouracil

Abstract

SUMMARY To study the effects of preoperative radiochemotherapy (RCT) on the healing of colonic anastomosis, the rectosigmoid colon in male Wistar rats was irradiated up to an end dose of 41.6 Gy (RT) or sham-irradiated (SR). During the last 5 days of the irradiation schedule, 5-fluorouracil (5-FU) was administered intraperitoneally in either a high dose (20 mg/kg, chemotherapy-high dose [CH]) or a low dose (10 mg/kg, chemotherapy-low dose [CL]). Animals were randomly arranged into six groups: group I, control (SR + saline intraperitoneally); group II, RT only; group III, SR + CL; group IV, RT + CL; group V, SR + CH; group VI, RT + CH. Four days after RCT, a side-to-side anastomosis was constructed between the irradiated rectosigmoid and the nonirradiated caecum. Animals were killed 10 days postoperatively. No significant differences were found in the anastomotic bursting pressure or the bursting wall tension. In group VI, mitoses were less (P < 0.01) and mucosal ulceration was more (P = 0.03) pronounced compared to group I. Sclerotic arteries were seen in all irradiated groups and in animals that received high-dose 5-FU alone. 5-FU administration in high or low dose, with or without RT, induced more inflammation in the submucosa compared to controls (P < 0.05). Conclusively, RCT has no detrimental effect on the mechanical strength of colonic anastomosis in this rat model. However, RCT with high-dose 5-FU induces more histological alterations at the anastomotic site.

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

“…Various outcomes have been reported in the studies investigating the effects of 5-FU on wound healing. 31,[37][38][39][40][41][42] Nonetheless, 5-FU is the cytotoxic agent of choice in colorectal cancer CT and has the characteristics of existing on the peritoneal surface for long term and passing into the portal circulation in high amounts. 42 In the present study we used 5-FU together with preoperative RT.…”

An oblique anastomosis has more linear length than a transverse anastomosis of a tubular structure in oesophageal anastomosis

“…In both groups, the bursting pressure was measured 8 weeks after operation to let the wound heal completely and to identify outcomes of oesophageal anastomosis. BP was measured pneumatically using a sphygmomanometer by the method defined by El-Malt et al [7]. Without disturbing the adhesions, the oesophagus (2 cm above and below the anastomosis) was tied with a 2-0 silk tie.…”

Determination of operation time in colorectal diseases: Preoperative chemotherapy application

“…Bursting pressure of the removed colonic segment was measured pneumatically using a sphingomanometer by the method defined by El-Malt et al [6]. Both ends of the colonic segment containing the anastomosis were tied up, and a catheter fixed to one end was connected to the sphingomanometer, and the segment was inflated.…”