Preoperative Irradiation Combined with Chemotherapy Impairs Healing of Bronchial Anastomosis During the Early Postoperative Period in Rats

Inoue, Masao; Oka, Teruaki; Y, Shima; Shirafuji, Tomoyuki; Sumida, Yorihisa; Yamashita, Hideki; Muraoka, Masashi; Nagayasu, Takeshi; Akamine, Shinji; Shimokawa, Isao; Ayabe, Hiroyoshi

doi:10.1620/tjem.199.1

Cited by 5 publications

(8 citation statements)

References 24 publications

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“…Thus, it is conceivable that LEH may cause suppression of inflammatory reaction, through HIF-1alpha signal transduction or monocyte-macrophage activation, to accelerate the healing process after ischemic, hypoxic, or surgical injury. Later, as the wound cleaning phase progresses, granulation occurs in the fibrosis period (21,25) when the effects of positive (i.e., LEH) or negative interventions (i.e., IR) become less pronounced, as shown in previous studies (17,20). While O2 metabolism is apparently involved (8), LEH appears to be one of the multiple factors that influence wound healing, as a large number of animals was required to delineate a difference with a wide scattering of bursting pressure in the current study.…”

Section: Discussionmentioning

confidence: 62%

“…Moreover, the number of rats with bursting pressure <100 mm Hg, equivalent to 20 mm Hg in humans when the diameter is considered, was less among LEH-treated rats than control rats receiving saline regardless of preceding IR. Although the experimental setup was different from the study of compromised animals by Inoue et al (20), wound healing was more suppressed earlier after surgery than later when the healing process prevailed. In contrast to these animal experiments, BPF often occurs 1 or 2 weeks after surgery in clinics, likely as the result of a gradual reduction in mechanical strength due to delayed healing from factors inherent to clinical comorbidities (1)(2)(3)(4).…”

Section: Discussionmentioning

confidence: 87%

“…Chest IR was used to compromise the animals in respect to wound healing, as it adversely affects bronchial endothelial blood flow and retards healing . A dosage of 20 Gy was selected to avoid life‐threatening systemic adverse effects remaining longer than 7 days . From previous experimental studies, 4 days after 20 Gy IR was chosen as the timing for pneumonectomy, based on the observation that there was no apparent retardation in wound healing 3 days postradiation .…”

Section: Discussionmentioning

confidence: 99%

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Liposome-Encapsulated Hemoglobin Accelerates Bronchial Healing After Pneumonectomy in the Rat With or Without Preoperative Radiotherapy

et al. 2014

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Liposome-encapsulated hemoglobin (LEH) has been reported to accelerate wound healing in the stomach and skin in an experimental setting. LEH was tested in bronchial anastomotic healing after radiation and pneumonectomy in the rat. Sprague-Dawley rats (n = 61) received preoperative radiation (20 Gy) to the chest and underwent left pneumonectomy with bronchial stump closure using the Sweet method 4 days later, when they were randomized to receive intravenous infusion of LEH with high O2 affinity (P50 O2 = 17 mm Hg, 10 mL/kg, n = 32) or saline (n = 29). Additional rats (n = 18) were treated in the same way without preoperative radiation. Bronchial anastomotic healing was evaluated 2 days after surgery by determining the bursting pressure and infiltration of neutrophils, monocytes, and macrophages. Bronchial bursting pressure was elevated in the rats receiving LEH both in the unirradiated group (LEH 212 ± 78 vs. saline 135 ± 63 mm Hg, P < 0.05) and in rats with preoperative radiation (LEH 162 ± 48 vs. saline 116 ± 56 mm Hg, P < 0.01). Moreover, the percentage of rats with bursting pressure <100 mm Hg tended to be smaller in the unirradiated group (LEH 1/9 [11.1%] vs. saline 4/9 [44.4%], NS) and was significantly reduced in irradiated animals (LEH 3/32 [9.4%] vs. saline 11/29 [38%], P < 0.05). There were no morphological differences except for macrophage infiltration to the anastomotic area, which was significantly prominent in the LEH-treated rats (P < 0.05) regardless of the presence or absence of preoperative irradiation (IR). The results suggest that LEH with high O2 affinity may improve mechanical strength and morphological findings in bronchial anastomosis in rats regardless of the presence or absence of preoperative IR. The irradiated rats later treated with LEH had equivalent or better bronchial healing than that of saline-treated naïve animals undergoing pneumonectomy alone.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Liposome-Encapsulated Hemoglobin Accelerates Bronchial Healing After Pneumonectomy in the Rat With or Without Preoperative Radiotherapy

et al. 2014

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“…Although the effect of acute radiotherapy on bronchial anastomosis has been experimentally and clinically demonstrated, there are limited numbers of studies about the effect of the preoperative chemotherapy on postsurgical tracheobronchial wound healing. [7,8] Inoue et al [5] demonstrated that preoperative chemotherapy impaired bronchial healing in their experimental study. This condition may be linked with subgroups of leukocytes, which are peripheral blood cells, including neutrophils, monocytes, lymphocytes, eosinophils, and basophils.…”

Section: Discussionmentioning

confidence: 98%

“…Rabbits in group 2 were given cisplatin 4 mg/kg at preoperative first day and etoposide 4.8 mg/kg at preoperative first, second, and third days through ear vein. Dose of the chemotherapeutics was the same with the dose administered to the rats in the experimental study performed by Inoue et al [5] Surgical procedure, anesthesia, prophylaxis, and analgesia were identical with group 1. Sacrifications were done at postoperative third, fifth, and seventh days and anastomosis lines were removed for pathological examination.…”

Section: Methodsmentioning

confidence: 99%

The effects of preoperative chemotherapy and beta glucan on bronchial anastomosis in rabbits: a preliminary study

Altuntas¹,

Ceran²,

Güven³

et al. 2015

Turk Gogus Kalp Dama

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Bu çalışmada ameliyat öncesi dönemde kemoterapi gören tavşanlarda bir immünstimülan olan beta glukanın bronş anastomozuna etkileri araştırıldı. Ça lış ma pla nı: Bu çalışmada kırk beş Yeni Zelanda türü erkek tavşan kullanıldı. Tavşanlar her birinde 15 tavşan olacak şekilde grup 1 (kontrol), grup 2 (kemoterapi) ve grup 3 (kemoterapi + beta glukan) olarak üç gruba bölündü. Tüm gruplarda sol ana bronş tam olarak kesildi ve daha sonra uç uca anastomoz yapıldı. Grup 2'de ameliyat öncesi birinci günde sisplatin ve ameliyat öncesi birinci, ikinci ve üçüncü günde etoposid uygulandı. Grup 3'te aynı kemoterapi protokolüne ilave olarak ameliyattan yedi gün önceden başlanarak sakrifikasyonların bir gün öncesine kadar enteral yolla 10 mg/kg/gün beta glukan verildi. Tavşanlar ameliyat sonrası üçüncü, beşinci ve yedinci günlerde beşerli gruplar halinde sakrifiye edildi. Bronşiyal anastomoz hatları çıkarıldı ve doku kesitleri hematoksilin ve eozin ile boyandı. Bul gu lar: Patolojik incelemede grup 1 ve grup 2 arasında ve grup 2 ve grup 3 arasında istatistiksel olarak anlamlı farklılık var iken grup 1 ve grup 3 arasında bronş iyileşmesi açısından farklılık yok idi. So nuç: Kemoterapi tedavisi sırasında beta glukan kullanılması ameliyat sonrası dönemde bronşiyal iyileşmeyi düzeltebilir.

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Optimal timing of surgery for bronchial sleeve resection after neoadjuvant chemoradiotherapy

Koryllos¹,

Lopez‐Pastorini²,

Zalepugas³

et al. 2020

Journal of Surgical Oncology

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Introduction Sleeve resection is an established oncological operative treatment for centrally located tumors with reduced complications compared to pneumonectomy. In cases of neoadjuvant chemoradiotherapy, the optimal timing of surgery for bronchial anastomotic healing has not been adequately explored. Materials and Methods Between 2006 and 2017, 584 tracheobronchial sleeve resections were retrospectively analyzed. We selected all patients (n = 88) after sleeve lobectomy or sleeve bilobectomy for lung cancer with fully completed neoadjuvant chemoradiotherapy. Bronchial healing was assessed by bronchoscopy on the 7th postoperative day using our earlier published classification from grades 1 to 5. Results The median interval to surgery was 50 days (interquartile range 46‐53, mean 50.03 ± 3.72). Mean anastomotic grade was 2.05 ± 1.03 and in 29.5% of the patients a critical anastomosis (grade ≥3) was documented. Anastomotic healing showed optimal results (bronchoscopic grade mean value: 1.5 ± 0.70) between the 6th and 8th postchemoradiotherapy week (P = .001). All patients operated before (bronchoscopic grade mean value: 2.3 ± 1.02) or after the above period (bronchoscopic grade mean value: 2.5 ± 1.15) had an increased ratio of anastomotic healing complications. Conclusion It is safer to perform sleeve‐resections for non‐small cell lung cancer after neoadjuvant trimodal treatment between the 6th and 8th week of completion of chemoradiotherapy.

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Preoperative Irradiation Combined with Chemotherapy Impairs Healing of Bronchial Anastomosis During the Early Postoperative Period in Rats

Cited by 5 publications

References 24 publications

Liposome-Encapsulated Hemoglobin Accelerates Bronchial Healing After Pneumonectomy in the Rat With or Without Preoperative Radiotherapy

Liposome-Encapsulated Hemoglobin Accelerates Bronchial Healing After Pneumonectomy in the Rat With or Without Preoperative Radiotherapy

The effects of preoperative chemotherapy and beta glucan on bronchial anastomosis in rabbits: a preliminary study

Optimal timing of surgery for bronchial sleeve resection after neoadjuvant chemoradiotherapy

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