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YARDIMCI VH. Farklı Dozlarda Intraperitoneal 5-Fluorouracil Kullanımının Deneysel Intestinal Anastomozların İyileşme Süresi Üzerine Etkileri. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.38079/igusabder.731424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Keceli HG, Ercan N, Karsiyaka Hendek M, Kisa U, Mesut B, Olgun E. The effect of the systemic folic acid intake as an adjunct to scaling and root planing on clinical parameters and homocysteine and C-reactive protein levels in gingival crevicular fluid of periodontitis patients: A randomized placebo-controlled clinical trial. J Clin Periodontol 2020; 47:602-613. [PMID: 32109317 DOI: 10.1111/jcpe.13276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 01/09/2023]
Abstract
AIM To evaluate clinical and biochemical effects of adjunctive systemic folic acid (FA) intake with scaling and root planing (SRP) in periodontitis treatment. MATERIALS AND METHODS Sixty periodontitis subjects (30 per group) were randomly assigned into study groups and treated with either SRP + placebo (SRP + P) or SRP + folic acid (SRP + F). In addition to clinical parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD], clinical attachment level [CAL] and gingival recession [GR]), gingival crevicular fluid (GCF) samples were obtained at baseline and post-treatment (PT) periods (one (PT-1), three (PT-3) and six (PT-6) months) for C-reactive protein (CRP) and homocysteine (Hcy) evaluation. RESULTS Significant time-dependent reduction was detected at all clinical parameters for both groups (p < .001). Compared to SRP + P, CAL was lower in SRP + F at PT-1 (p = .004) and PT-3 (p = .035), whereas GR was lower at only PT-1 (p = .015). GCF volume and CRP did not show inter-group differences, whereas Hcy was higher in SRP + F at PT-3 (p = .044) and PT-6 (p = .041). GCF volume and Hcy showed reduction after treatment in both groups (p < .001). CONCLUSION Both modalities exhibited clinical improvement and change in biochemical parameters. Adjunctive systemic FA intake may be recommended adjunctive to periodontitis treatment to reveal better outcomes. However, its impact mechanisms should be further enlightened.
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Affiliation(s)
- H Gencay Keceli
- Periodontology Department, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Nuray Ercan
- Oral Health and Dental Care Centre, Duzce, Turkey
| | | | - Ucler Kisa
- Biochemistry Department, Faculty of Medicine, Kirikkale University, Kırıkkale, Turkey
| | - Burcu Mesut
- Pharmaceutical Technology Department, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Ebru Olgun
- Periodontology Department, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
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Jeong WK, Shin JW, Baek SK. Oncologic outcomes of early adjuvant chemotherapy initiation in patients with stage III colon cancer. Ann Surg Treat Res 2015; 89:124-30. [PMID: 26366381 PMCID: PMC4559614 DOI: 10.4174/astr.2015.89.3.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/13/2015] [Accepted: 04/09/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose Although adjuvant chemotherapy reduces the risk of disease recurrence in stage III colon cancer patients, published guidelines do not specify when it should be initiated. This study aimed to assess the effect of adjuvant chemotherapy initiation time on disease recurrence and survival in stage III colon cancer patients undergoing curative surgical resection. Methods The medical records of stage III colon cancer patients undergoing curative resection between February 2004 and December 2009 were reviewed. Results Of the 133 enrolled patients, 27 (20.3%) began adjuvant chemotherapy within 3 weeks of surgery, whereas 106 (79.7%) did after 3 weeks following surgery. Patients receiving chemotherapy within 3 weeks of surgery were less likely to experience recurrences than those beginning treatment later (11.1% vs. 33%, P = 0.018). The mean disease-free survival of patients receiving adjuvant therapy earlier was 54.6 months, whereas that of patients with later treatment was 43.5 months (P = 0.014). However, no significant differences in overall survival were observed between the 2 groups. Conclusion Adjuvant chemotherapy should be initiated as soon as a patient's clinical condition allows. Patients with stage III colon cancer may benefit from adjuvant chemotherapy initiated within 3 weeks of surgery.
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Affiliation(s)
- Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Je-Wook Shin
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
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Duman L, Büyükyavuz BI, Altuntas I, Gökcimen A, Ceyhan L, Darici H, Aylak F, Tomruk O. The efficacy of single-dose 5-fluorouracil therapy in experimental caustic esophageal burn. J Pediatr Surg 2011; 46:1893-7. [PMID: 22008323 DOI: 10.1016/j.jpedsurg.2011.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 02/21/2011] [Accepted: 03/02/2011] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Accidental ingestion of caustic substances may cause serious problems in children. Approximately 20% of caustic ingestions result in esophageal stricture formation, resulting from excessive collagen synthesis to the extracellular matrix by fibroblasts. Recent studies showed that a single application of 5-fluorouracil (5-FU) is a very effective inhibitor of fibroblast proliferation and differentiation for prolonged periods. Using an experimental model, we investigated the efficacy of single-dose 5-FU on stricture formation after caustic esophageal burn. MATERIALS AND METHODS Forty Wistar-Albino rats were divided randomly into 4 equal groups: group 1 (sham-operated group), the esophagus was uninjured and untreated; group 2 (control group), the esophagus was injured and left untreated; group 3 (intraperitoneal treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraperitoneal dose (20 mg/kg) of 5-FU; group 4 (local treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraesophageal application of 5-FU at a concentration of 25 mg/mL. Caustic esophageal burn was produced by instilling 10% NaOH in the distal esophagus. The distal esophagi were harvested at 28 days postoperatively. Histologic sections were assessed by measuring the stenosis index (SI) and histopathologic damage score. Hydroxyproline (HP) levels in the tissues were determined biochemically. RESULTS There were significant reductions in the SI (P < .05), histopathologic damage score (P < .05), and HP level (P < .05) in the intraperitoneal treatment group when compared with the control group. No significant differences in the SI and histopathologic damage score were detected between the control and local treatment groups (P > .05), whereas significant reduction in the HP level was determined between these groups (P < .05). CONCLUSION A single intraperitoneal dose of 5-FU had a preventive effect on stricture formation after caustic esophageal burn. This observation suggests that 5-FU may prevent this undesirable complication in the clinical setting. Clinical studies are now required to verify this form of treatment. Local intraesophageal application of 5-FU immediately after the burn injury was not effective. Further investigations are required to determine the appropriate timing of application of 5-FU at the local site of injury.
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Affiliation(s)
- Levent Duman
- Department of Pediatric Surgery, Süleyman Demirel University Medical School, 32260, Isparta, Turkey.
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Blouhos K, Pramateftakis MG, Tsachalis T, Kanellos D, Zaraboukas T, Koliakos G, Betsis D. The integrity of colonic anastomoses following the intraperitoneal administration of oxaliplatin. Int J Colorectal Dis 2010; 25:835-41. [PMID: 20217424 DOI: 10.1007/s00384-010-0912-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2010] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this experimental study was to determine the effect of oxaliplatin on the integrity of colonic anastomoses which were under oxaliplatin administration. MATERIALS AND METHODS Thirty rats were randomized to two groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. Rats of the control group were injected with 3 ml of 0.9% sodium chloride solution and in the oxaliplatin group with 2.4 mg/kg of oxaliplatin intraperitoneally immediately after surgery and for seven postoperative days. All rats were sacrificed on the tenth postoperative day, and the anastomoses were examined macroscopically and graded histologically. Rats were measured for anastomotic bursting pressures and tissue hydroxyproline levels. RESULTS The body weight changes were significantly greater in the oxaliplatin group (p = 0.005). Anastomotic dehiscence occurred only in the oxaliplatin group. The adhesion formation was significantly increased in the group of oxaliplatin compared to the control group (p = 0.001). The colonic bursting pressure was significantly lower in the oxaliplatin group compared to the control group (p < 0.001). The mean inflammatory cell infiltration was significantly lower in the oxaliplatin group (1.00 vs. 2.33, p < 0.001). The mean neoagiogenesis was significantly lower in the oxaliplatin group (0.80 vs. 2.20, p < 0.001). The mean collagen deposition was significantly lower in the oxaliplatin group and the mean fibroblast activity was significantly lower in the oxaliplatin group (1.27 vs. 2.53, p < 0.001). Hydroxyproline concentration was significantly lower in the oxaliplatin group (p < 0.001). CONCLUSION Intra- and postoperative intraperitoneal administration of oxaliplatin definitely impairs healing of colonic anastomoses in rats.
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Affiliation(s)
- Konstantinos Blouhos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Hada M, Omura K, Hirano Y, Watanabe G. Changes in bowel mucosal permeability and wound healing after neoadjuvant chemotherapy. Oncol Lett 2010; 1:161-165. [PMID: 22966276 DOI: 10.3892/ol_00000030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 06/29/2009] [Indexed: 11/06/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) with 5-fluorouracil (5-FU) and cisplatin (CDDP) is a promising approach for locally advanced gastric cancer. We investigated the influence of NAC with 5-FU/CDDP on the permeability of intestinal mucosa and wound healing. Male Sprague Dawley rats were divided into four groups (n=6). Group 1 received saline (control group) and Groups 2-4 were administered preoperative 5-FU/CDDP (NAC groups). The NAC consisted of daily intraperitoneal administration of 5-FU from day 1 to 5 and from day 8 to 12 and intravenous administration of CDDP on days 2 and 9. The rats underwent gastrotomy (1.0 cm) with a laparotomy of 3 cm in length, under general anesthesia. Seven days after surgery, the rats were orally administered with phenolsulfonphthalein (PSP), and the 24-h urinary excretion of PSP was quantified. On postoperative day 8, the bursting pressure (BP) of the gastric suture line and the tensile strength of the abdominal wound were measured. The hydroxyproline (HP) content in the tissue of the abdominal suture line was then measured, and the number of fibroblast cells in the tissue of the gastric suture line was calculated by histopathological examination. The PSP urinary excretion rate was significantly higher in Group 2 in comparison with the other groups (P<0.05), while the BP of a selected gastrorrhaphy region was significantly lower in Group 2 (P<0.05). No significant differences were noted in the HP content. NAC with 5-FU/CDDP disturbs the healing of intestinal anastomoses when the interval between chemotherapy and surgery is insufficient. Neither HP content nor fibroblast counts were correlated with BP. Consequently, NAC appeared to affect the remodeling of collagen fiber. Thus, the integrity of the intestine may play a role in intestinal wound healing.
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Affiliation(s)
- Masahiro Hada
- General and Cardiothoracic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641
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Ozel L, Ozel MS, Toros AB, Kara M, Ozkan KS, Tellioglu G, Krand O, Koyuturk M, Berber I. Effect of early preoperative 5-fluorouracil on the integrity of colonic anastomoses in rats. World J Gastroenterol 2009; 15:4156-62. [PMID: 19725150 PMCID: PMC2738812 DOI: 10.3748/wjg.15.4156] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the effect of chemotherapy on wound healing by giving early preoperative 5-fluorouracil (5-FU) to rats with colonic anastomoses.
METHODS: Sixty Albino-Wistar male rats (median weight, 235 g) were used in this study. The rats were fed with standard laboratory food and given tap water ad libitum. The animals were divided into three groups: Group 1: Control group (chemotherapy was not administered), Group 2: Intraperitoneally (IP) administered 5-FU group (chemotherapy was administered IP to animals at a dose of 20 mg/kg daily during the 5 d preceeding surgery), Group 3: Intravenously (IV) administered 5-FU group. Chemotherapy was administered via the penil vein, using the same dosing scheme and duration as the second group. After a 3-d rest to minimize the side effects of chemotherapy, both groups underwent surgery. One centimeter of colon was resected 2 cm proximally from the peritoneal reflection, then sutured intermittently and subsequently end-to-end anastomosed. In each group, half the animals were given anaesthesia on the 3rd postoperative (PO) day and the other half on the 7th PO day, for in vivo analytic procedures. The abdominal incisions in the rats were dissected, all the new and old anastomotic segments were clearly seen and bursting pressures of each anastomotic segment, tissue hydroxyproline levels and DNA content were determined to assess the histologic tissue repair process.
RESULTS: When the IV group was compared with the IP group, bursting pressures of the anastomotic segments on the 3rd and 7th PO days, were found to be significantly decreased, hydroxyproline levels at the anastomotic segment on the 7th PO day were significantly decreased (P < 0.01).
CONCLUSION: In this study, we conclude that early preoperative 5-FU, administered IV, negatively affects wound healing. However, IP administered 5-FU does not negatively affect wound healing.
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Healing of colonic anastomoses after immediate postoperative intraperitoneal administration of oxaliplatin. Int J Colorectal Dis 2008; 23:1185-91. [PMID: 18677490 DOI: 10.1007/s00384-008-0538-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2008] [Indexed: 02/04/2023]
Abstract
AIM The aim of this experimental study was to investigate the effect of intraperitoneal administration of oxaliplatin on the healing of colonic anastomoses when injected immediately after colon resection. MATERIALS AND METHODS Thirty male Wistar rats were used. During the operation, the rats were randomized to two groups of 15 rats each. Immediately after colonic anastomoses were performed, the rats were injected intraperitoneally with either 3 ml of 0.9% NaCl solution or oxaliplatin (2.4 mg/kg body weight) depending on their group. All rats were killed on the eighth postoperative day. The anastomoses were examined macroscopically. The anastomotic bursting pressures were recorded, the anastomoses graded histologically, and the hydroxyproline tissue contents determined. RESULTS Anastomotic leakage was noted in four rats (26.7%) of the oxaliplatin group, whereas no anastomotic dehiscence was detected among rats of the control group (p = 0.016). The adhesion formation at the anastomotic sites and the inflammatory cell infiltration were significantly higher in the oxaliplatin group than in the control group (p = 0.001). The bursting pressures (p = 0.001), the hydroxyproline tissue content (p = 0.001), the neoangiogenesis (p = 0.033), the fibroblast activity (p = 0.001), and the collagen deposition (p = 0.001) were significantly lower in the oxaliplatin group in comparison to the control group. CONCLUSION The immediate postoperative intraperitoneal administration of oxaliplatin seems to impair healing of colonic anastomoses in rats.
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Teke Z, Sacar M, Yenisey C, Atalay AO, Bicakci T, Erdem E. Activated protein C prevents deleterious effects of remote reperfusion injury caused by intestinal ischemia on wound healing in the left colonic anastomoses: an experimental study in the murine model. Am J Surg 2008; 196:774-87. [PMID: 18466864 DOI: 10.1016/j.amjsurg.2007.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 09/13/2007] [Accepted: 09/13/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Activated protein C (APC) is a serine protease with anticoagulant and antiinflammatory activities. The delaying effects of remote reperfusion injury on the wound-healing process in colonic anastomoses have been previously shown. In this study, we aimed to investigate whether APC protects against deleterious systemic effects of intestinal ischemia/reperfusion (I/R) injury on colonic anastomotic wound healing process. METHODS Male Wistar-albino rats were randomly allocated into 4 groups, and a left colonic anastomosis was performed in all animals: (1) sham-operated group, simultaneously with left colonic anastomosis, the superior mesenteric artery and collateral branches were divided from the celiac axis, and the inferior mesenteric artery were isolated but not occluded (group 1, n = 12), (2) sham + APC group, identical to group 1 except for APC treatment (100 microg/kg, intravenously, 15 minutes before construction of the colonic anastomosis), (group 2, n = 12), (3) intestinal I/R group, 60 minutes of superior mesenteric ischemia followed by reperfusion (group 3, n = 12), and (4) APC-treated group, (100 microg/kg, intravenously, 15 minutes before reperfusion) (group 4, n = 12). All animals were sacrificed, and colonic anastomotic bursting pressures were measured in vivo on day 7. Tissue samples were obtained for analysis of hydroxyproline contents, nitrate/nitrite levels, and activities of oxidative and antioxidative enzymes. The plasma levels of proinflammatory cytokines and D-dimer were also measured. RESULTS Intestinal I/R led to significant decreases in colonic anastomotic bursting pressures, tissue hydroxyproline contents, and activities of antioxidative enzymes, along with increases in tissue nitrate/nitrite levels, activities of oxidative enzymes, and plasma levels of proinflammatory cytokines and D-dimer (P < .05). However, APC treatment led to significant increases in colonic anastomotic bursting pressures, tissue hydroxyproline contents, and activities of antioxidative enzymes, along with decreases in tissue nitrate/nitrite levels, activities of oxidative enzymes, and plasma levels of proinflammatory cytokines and D-dimer (P < .05). CONCLUSION This study clearly showed that APC treatment prevented the delaying effects of remote I/R injury on colonic anastomotic wound healing process. Further clinical studies are required to determine whether APC has a useful role in the enhancement of colonic anastomotic wound healing after particular operations in which I/R injury occurs.
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Affiliation(s)
- Zafer Teke
- Department of General Surgery, Pamukkale University, School of Medicine, 20070, Kinikli, Denizli, Turkey.
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Zacharakis E, Demetriades H, Pramateftakis MG, Lambrou I, Zacharakis E, Zaraboukas T, Koliakos G, Kanellos I, Betsis D. Effect of IGF-I on healing of colonic anastomoses in rats under 5-FU treatment. J Surg Res 2007; 144:138-44. [PMID: 17640667 DOI: 10.1016/j.jss.2007.03.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Revised: 01/29/2007] [Accepted: 03/19/2007] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this experimental study was to investigate whether insulin-like growth factor I (IGF-I) can protect the colonic healing from the adverse effects of intraperitoneal administration of 5-fluorouracil (5-FU). MATERIALS AND METHODS Eighty male Wistar rats were randomized into four groups of 20 rats each. Immediately after anastomoses were performed, rats in the control group were injected with 1 mL/100 gr of intraperitoneal saline solution, which was repeated daily until killed. Rats in the 5-FU and IGF-I +5-FU groups received 5-FU in a dose of 20 mg/kg body weight intraperitoneally, from the day of operation until killed. Rats in the IGF-I and IGF-I +5-FU groups received IGF-I in a dose of 2 mg/kg body weight intraperitoneally, immediately after the colonic anastomosis was performed and on 2nd, 4th, and 6th postoperative day. Rats were sacrificed on the 7th postoperative day. RESULTS The dehiscence rate in the 5-FU group was 30% and it was significantly higher compared with the control and the IGF-I group (P = 0.020 for both comparisons). However, in the IGF-I +5-FU group, the dehiscence rate decreased to 10%. The administration of IGF-I resulted in a significant rise of bursting pressure in the IGF-I +5-FU group compared with the 5-FU group (P < 0.001). There was no statistical difference in bursting pressure between the IGF-I +5-FU and control groups (P = 1.000). The hydroxyproline levels were higher in the IGF-I and the IGF-I +5-FU groups as a result of the stimulating act of IGF-I. CONCLUSION IGF-I, when given intraperitoneally, seems to mediate some of the adverse effects of 5-FU on the colonic healing in rats.
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Affiliation(s)
- Emmanouil Zacharakis
- 4th Academic Surgical Unit, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Makedonia, Greece.
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Vasiliadis K, Pramateftakis MG, Blouhos K, Mantzoros I, Koliakos G, Zaraboukas T, Kanellos I, Demetriades H, Alamdari DH, Betsis D. Effect of iloprost on impaired anastomotic healing caused by 5-fluorouracil plus leucovorin. Dis Colon Rectum 2007; 50:899-907. [PMID: 17353975 DOI: 10.1007/s10350-006-0878-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This experimental study was designed to investigate whether iloprost can reverse impaired colonic healing caused by immediate postoperative intraperitoneal administration of 5-fluorouracil plus leucovorin. METHODS Eighty Wistar rats were randomized into four groups. After resection of a 1-cm segment of transverse colon, an end-to-end sutured anastomosis was generated. Rats received saline solution (Group 1), 5-fluorouracil plus leucovorin (Group 2), iloprost (Group 3), and 5-fluorouracil plus leucovorin plus iloprost (Group 4) intraperitoneally from the day of operation and once daily until killing. Each group was further randomized into two subgroups. Subjects were killed on the fifth (Subgroup a) and eighth (Subgroup b) postoperative days. After killing, anastomoses were examined macroscopically and graded histologically. Rats were measured for anastomotic bursting pressures and tissue hydroxyproline levels. RESULTS The leakage rate of the anastomoses was significantly higher in the 5-fluorouracil plus leucovorin group compared with the other groups (P = 0.049). Bursting pressure was significantly lower in 2a subgroup (5-fluorouracil plus leucovorin, postoperative Day 5) than in 4a (5-fluorouracil plus leucovorin plus iloprost, postoperative Day 5; P < 0.001). Adhesion formation was significantly higher in all b subgroups compared with the Control b subgroup. Neoangiogenesis was significantly higher in iloprost and iloprost plus 5-fluorouracil plus leucovorin subgroups compared with the 5-fluorouracil plus leucovorin subgroups. Hydroxyproline levels, collagen deposition, fibroblasts, and white cell count were significantly higher in the iloprost plus 5-fluorouracil plus leucovorin b subgroup (postoperative Day 8) compared with the 5-fluorouracil plus leucovorin b subgroup (postoperative Day 8). CONCLUSIONS The immediate postoperative, intraperitoneal administration of iloprost counteracts and reverses the negative effects of 5-fluorouracil plus leucovorin chemotherapy and protects colonic healing in rats.
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Affiliation(s)
- K Vasiliadis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Colak T, Dag A, Turkmenoglu O, Polat A, Comelekoglu U, Bagdatoglu O, Polat G, Akca T, Sucullu I, Aydin S. The effect of octreotide on healing of injured colonic anastomosis with immediate postoperative intraperitoneal administration of 5-Fluorouracil. Dis Colon Rectum 2007; 50:660-9. [PMID: 17216142 DOI: 10.1007/s10350-006-0810-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to investigate the effect of octreotide on side effects of immediate usage of 5-fluorouracil after colonic anastomosis. METHODS Forty male Wistar rats were randomly assigned into four groups and underwent standardized left colonic anastomosis. The rats served as control or received intraperitoneal 5-fluorouracil (20 mg/kg daily), subcutaneous octreotide (20 mug/kg daily), or both. Diarrhea and wound complications were noted during the experiment. The colonic anastomoses were assessed for healing on postoperative Day 7 by determining the anastomotic bursting pressure, performing histologic examination, and measuring the tissue hydroxyproline content, serum malondialdehyde, and nitric oxide levels. Intraperitoneal adhesions and anastomotic leakage were also noted. RESULTS No statistical significant difference was found between the control and octreotide groups for each of the parameters measured. Immediate 5-fluorouracil use resulted with higher adhesion score (P = 0.002), significant depression in anastomotic bursting pressure (P = 0.0001), histopathologic score (P = 0.0001), hydroxyproline content (P = 0.0001), and increasing nitric oxide (P = 0.0001) and malondialdehyde levels (P = 0.0001) compared with the control group. Diarrhea was seen in 80 percent of the 5-fluorouracil group but in neither the control nor octreotide groups (P = 0.0001 for each comparison). However, all these parameters were ameliorated by use of concomitant octreotide and 5-fluorouracil (P = 0.019, P = 0.023, P = 0.0001, P = 0.006, P = 0.0001, and P = 0.013, respectively). In addition, diarrhea was found to be prevented (P = 0.0001). CONCLUSIONS The results of this study showed that concomitant octreotide use might prevent the side effects of 5-fluorouracil, such as diarrhea, postoperative adhesion, and delaying the anastomotic healing parameters. In addition, it might reduce tissue damage and inflammation.
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Affiliation(s)
- Tahsin Colak
- Faculty of Medicine, Department of General Surgery, Mersin University, Tip Fakultesi Hastanesi, Zetinlibahce C., Mersin, 33097, Turkey.
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Kanellos D, Blouhos K, Pramateftakis MG, Kanellos I, Demetriades H, Sakkas L, Betsis D. Effect of 5-Fluorouracil plus Interferon on the Integrity of Colonic Anastomoses Covering with Fibrin Glue. World J Surg 2006; 31:186-91. [PMID: 17171478 DOI: 10.1007/s00268-006-0094-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND It has been well established that the immediate postoperative intraperitoneal administration of chemotherapeutic agents such as 5-fluorouracil (5-FU) after curative colon resection for colon cancer destroys disseminated cancer cells and inhibits micrometastases but also inhibits anastomotic healing. On the other hand, the application of fibrin glue constitutes a physical barrier around the anastomosis and may prevent anastomotic leakage. The purpose of this experimental study was to determine the effect of 5-FU plus interferon (IFN)-alpha-2a on the integrity of colonic anastomoses covered with fibrin glue when injected intraperitoneally immediately after colon resection. MATERIALS AND METHODS Sixty rats were randomized to one of four groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. Rats of the control and the fibrin glue groups were injected with 6 ml of 0.9% sodium chloride (NaCl) solution intraperitoneally. Rats in the 5-FU + IFN and the 5-FU + IFN + fibrin glue groups received 5-FU plus IFN intraperitoneally. The colonic anastomoses of the rats in the fibrin glue and in the 5-FU + IFN + fibrin glue groups were covered with fibrin glue. All rats were sacrificed on the 8th postoperative day, and the anastomoses were examined macroscopically. The bursting pressure measurements were recorded, and the anastomoses were graded histologically. RESULTS Only the 5-FU + IFN group had anastomoses rupture, and the rupture rate (33%) in this group was significantly greater than in the other groups, where there were no ruptures (P = 0.015). The adhesion formations score was, on average, significantly higher in rats of the 5-FU + IFN group compared with the control group (P = 0.006) and the 5-FU + IFN + fibrin glue group (P = 0.010). Bursting pressures were significantly lower in the control group when compared to the fibrin glue and 5-FU + IFN + fibrin glue group (P < 0.001). Rats in the 5-FU + IFN + fibrin glue group developed significantly more marked neoangiogenesis than rats in the other groups. Inflammatory cell infiltration, collagen deposition, and fibroblast activity did not differ significantly among the four groups (P = 0.856, P = 0.192 and P = 0.243, respectively). CONCLUSION The immediate postoperative intraperitoneal administration of 5-FU plus IFN impairs colonic healing. However, when the colonic anastomoses were covered with fibrin glue, the injection of 5-FU plus IFN had no adverse effects on the integrity of the anastomoses.
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Affiliation(s)
- D Kanellos
- 4th Department of Surgery, Aristotle University of Thessaloniki, Greece.
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Neiva RF, Al-Shammari K, Nociti FH, Soehren S, Wang HL. Effects of Vitamin-B Complex Supplementation on Periodontal Wound Healing. J Periodontol 2005; 76:1084-91. [PMID: 16018750 DOI: 10.1902/jop.2005.76.7.1084] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Reports have demonstrated that nutrient supplements, in particular vitamin-B complex (Vit-B), can positively influence wound healing processes. However, limited information is available on the effects of Vit-B on periodontal wound healing. METHODS A total of 30 patients (13 males, 17 females) presenting with generalized moderate to severe chronic periodontitis were enrolled in this study. All subjects presented > or = two teeth in the same sextant with probing depth (PD) > or =5 mm and bleeding upon probing (BOP) in need of access flap surgery (AFS). This study was a randomized, double-masked, placebo-controlled clinical trial. Subjects were instructed to take one capsule a day of either Vit-B (50 mg of the following: thiamine HCl, riboflavin, niacinamide, d-calcium pantothenate, and pyridoxine HCl; 50 microg each of d-biotin and cyanocobalamin; and 400 mcg of folate) or placebo for 30 days following AFS. Clinical attachment levels (CAL) and N-benzoyl-dl-arginine-2-naphthylamide (BANA) test scores were measured at baseline and at 90 and 180 days following surgical intervention. Assessments of the healing response were also performed using BOP, gingival index (GI), and plaque index (Pl) at baseline and 7, 14, 30, 90, and 180 days. The mean results of each parameter were averaged within a group. Differences between groups were analyzed by using repeated measures analysis of variance (ANOVA). RESULTS Both groups experienced comparable levels of PD reduction following AFS (test: -1.57 +/- 0.34; control: -1.50 +/- 0.21). Changes in mean CAL were more favorable in Vit-B supplemented subjects (test: +0.41 +/- 0.12; control: -0.52 +/- 0.23; P = 0.024). Stratified data demonstrated significantly better results for the test group in both shallow (test: -0.08 +/- 0.03; control: -1.11 +/- 0.27; P = 0.032) and deep sites (test: +1.69 +/- 0.31; control: +0.74 +/- 0.23; P = 0.037). No significant differences were observed between groups regarding PI, GI, and BOP. BANA test values were significantly reduced in both groups after surgical treatment and no significant differences were noted between groups. CONCLUSION Vitamin B-complex supplement in combination with AFS resulted in statistically significant superior CAL gains when compared to placebo.
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Affiliation(s)
- Rodrigo F Neiva
- Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, 1011 N. University Avenue, Ann Arbor, MI 48109-1078, USA.
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15
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Uzunkoy A, Bolukbas C, Horoz M, Bolukbas FF, Kocyigit A. The optimal starting time of postoperative intraperitoneal mitomycin-C therapy with preserved intestinal wound healing. BMC Cancer 2005; 5:31. [PMID: 15801977 PMCID: PMC1079801 DOI: 10.1186/1471-2407-5-31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2004] [Accepted: 03/31/2005] [Indexed: 11/17/2022] Open
Abstract
Background There is controversy about the effect of the timing of intraperitoneal administration of chemotherapeutic agents on the healing of intestinal anastomosis. We have investigated the effect on intestinal wound healing of mitomycin-C administered at different times post-operatively. Methods Eighty-four Wistar-Albino female rats underwent ileal resection and end-to-end anastomosis. The rats were randomly selected for intraperitoneal administration of mitomycin-C or saline as follows: mitomycin-C group (n = 65), 2 mg/kg mitomycin-C; control group (n = 13), 10 ml saline. The former was sub-divided into 5 equal groups (A 1–5) and mitomycin-C was administered postoperatively as follows: day 0 (A1), day 3 (A2), day 5 (A3), day 7 (A4) and day 10 (A5). All the rats were sacrificed on the 14th postoperative day and anastomotic bursting pressures and tissue hydroxyproline levels were determined. Results Five of the animals died postoperatively: 2 (15.4%) in group A1, 2 (15.4%) in group A2 and 1(7.7%) in group A3. Non-lethal anastomotic leakage was observed in a further five animals: 1 in group A1, 2 in group A2, 1 in group A5 and 1 in the control group. Groups A1 and A2 had significantly lower anastomotic bursting pressures than the other groups (P was <0.05 for each comparison). The anastomotic bursting pressures of group A3, A4 and A5 were comparable with those of the controls (P was >0.05 for each comparison). Tissue hydroxyproline levels in group A1 and A2 were significantly lower than in the controls (P values were <0.05 for each comparison) or the other mitomycin-C sub-groups (P was <0.05 for each comparison). Conclusions Intraperitoneal chemotherapy impairs intestinal wound healing when applied before the 5th postoperative day. Additional therapeutic approaches are needed to prevent this potentially lethal side effect of early intraperitoneal mitomycin-C administration.
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Affiliation(s)
- Ali Uzunkoy
- Department of Surgery, Harran University, Sanliurfa, Turkey
| | - Cengiz Bolukbas
- Department of Internal Medicine, Harran University, Sanliurfa, Turkey
| | - Mehmet Horoz
- Department of Internal Medicine, Harran University, Sanliurfa, Turkey
| | - Fusun F Bolukbas
- Department of Internal Medicine, Harran University, Sanliurfa, Turkey
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Kanellos I, Mantzoros I, Demetriades H, Kalfadis S, Kelpis T, Sakkas L, Betsis D. Healing of colon anastomoses covered with fibrin glue after immediate postoperative intraperitoneal administration of 5-fluorouracil. Dis Colon Rectum 2004; 47:510-5. [PMID: 14978614 DOI: 10.1007/s10350-003-0085-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this experimental study was to investigate whether covering the colonic anastomoses with fibrin glue can protect the colonic healing from the adverse effects of 5-fluorouracil (5-FU), when it is injected intraperitoneally immediately after colon resection. METHODS Sixty-four rats were randomized to one of four groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. Rats of the control group and the fibrin glue group were injected with 6 ml of solution 0.9 percent NaCl intraperitoneally. Rats in the 5-FU and the 5-FU + fibrin glue groups received 5-FU intraperitoneally. The colonic anastomoses of the rats in the fibrin glue group and in the 5-FU + fibrin glue group were covered with fibrin glue. All rats were killed on the 8th postoperative day and the anastomoses were examined macroscopically. The bursting pressure measurements were recorded and the anastomoses were graded histologically. RESULTS The leakage rate of the anastomoses was significantly higher in the rats of the 5-FU group than in those of the fibrin glue group and those of the 5-FU + fibrin glue group (37.5 percent vs. 0 percent, P = 0.020). The adhesion formation score was significantly higher in rats of the 5-FU group than in the other groups. Bursting pressures were also significantly lower in the 5-FUgroup than in the other groups ( P < 0.001). Rats in the 5-FU + fibrin glue group developed significantly more marked neoagiogenesis than rats in the other groups. Rats in the 5-FU + fibrin glue group also presented significantly more fibroblast activity than those in the 5-FU group. ( P = 0.004) CONCLUSIONS The immediate postoperative, intraperitoneal administration of 5-FU inhibited wound healing. However, when the colonic anastomoses were covered with fibrin glue, the injection of 5-FU had no adverse effects on the healing of the anastomoses.
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Affiliation(s)
- I Kanellos
- 4th Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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17
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Mahteme H, Hansson J, Berglund A, Påhlman L, Glimelius B, Nygren P, Graf W. Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study. Br J Cancer 2004; 90:403-7. [PMID: 14735184 PMCID: PMC2409568 DOI: 10.1038/sj.bjc.6601586] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with peritoneal or local metastases from colorectal cancer have a poor prognosis. However, aggressive treatments by debulking surgery and infusional intraperitoneal (i.p.) chemotherapy have been tried and appear to benefit selected patients. We assayed the effects of debulking surgery and i.p. chemotherapy with respect to survival and compared the results with matched control patients treated by intravenous (i.v.) chemotherapy. In all, 18 patients with peritoneal and/or local metastases from colorectal adenocarcinoma underwent debulking surgery followed by 5-fluorouracil (5-FU) 550 mg m−2 day−1 i.p. and leucovorin (LV) 60 mg m−2 day−1 i.v. The chemotherapy was started the day after surgery and was given daily for 6 days and repeated monthly for totally eight courses. The control patients, matched for age, gender, performance status and metastatic site, were randomly selected from controlled clinical chemotherapy trials and treated with i.v. 5-FU+LV or i.v. methotrexate+5-FU+LV. There was no treatment-related mortality. The median survival among i.p. patients was 32 months compared to 14 months in the control group. In all, 11 patients who underwent macroscopically radical surgery had a longer survival than those who were not radically operated (P=0.02). These results indicate that patients with peritoneal metastases and/or locally advanced cancers but without distant metastases may benefit from cytoreductive surgery combined with i.p. chemotherapy.
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Affiliation(s)
- H Mahteme
- 1Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala, Sweden.
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Neiva RF, Steigenga J, Al-Shammari KF, Wang HL. Effects of specific nutrients on periodontal disease onset, progression and treatment. J Clin Periodontol 2003; 30:579-89. [PMID: 12834494 DOI: 10.1034/j.1600-051x.2003.00354.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this paper is to review the available literature pertaining to the effects of specific nutritional elements (e.g. vitamin B-complex, vitamin C and dietary calcium) on general wound healing, periodontal disease status and response to periodontal therapy. METHODS Critical appraisal of various studies that have evaluated the effects of calcium, ascorbic acid and vitamin B-complex in wound healing and periodontal treatment. RESULTS Periodontal disease onset, progression and response to therapeutic interventions have been shown to be influenced by several systemic, local and environmental modifying factors. Nutritional supplementation has been suggested as a possible influencing factor on periodontal status and wound healing. Several studies have reported various degrees of association between nutritional elements/supplements and periodontal status, and others have reported possible positive influences of nutritional supplementation on periodontal therapeutic outcomes. Future research needs to more fully explore the presence and strength of association between nutrition and periodontal health. CONCLUSIONS Data collected from the literature suggests that nutrient supplementation causes minimal or no side effects. However, the efficacy of prophylactic nutrient supplementation for the prevention of the onset and progression of periodontal disease, or for the enhancement of periodontal wound healing, remains to be determined.
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Affiliation(s)
- Rodrigo F Neiva
- Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA
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Erdem E, Dinç S, Erdem D, Ustün H, Caydere M, Alagöl H. Effects of intraperitoneal chemotherapy and GM-CSF on anastomotic healing: an experimental study in rats. J Surg Res 2002; 108:1-6. [PMID: 12443708 DOI: 10.1006/jsre.2002.6425] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Intraperitoneal chemotherapy (IPCT) is an alternative local adjuvant treatment for patients with resectable colonic and gastric cancers. This is the simplest and safest method for systemic toxicity, but it can affect the healing of colonic anastomoses. Granulocyte macrophage-colony stimulating factor (GM-CSF) may be used to prevent this side effect by means of macrophage activity stimulation. METHODS In this experimental study the effects of early postoperative intraperitoneal 5-fluorouracil (5-FU) and local administration of recombinant human GM-CSF (rGM-CSF) were studied on rats. The anastomotic bursting pressures, hydroxyproline contents of tissues, and histological appearance were assessed. RESULTS It was found that anastomotic healing of colon was impaired after intraperitoneal 5-FU administration, but when rGM-CSF was injected to the both sides of the anastomoses locally, this side effect could be prevented. CONCLUSIONS IPCT may diminish the activity of macrophages and impair the wound healing; locally applied rGM-CSF enhanced wound healing on colonic anastomoses.
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Affiliation(s)
- Erhan Erdem
- Department of Pathology, Ankara Training and Research Hospital, Ankara, Turkey.
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Tekin K, Aytekin F, Ozden A, Bilgihan A, Erdem E, Sungurtekin U, Güney Y. Antithrombin III prevents deleterious effects of remote ischemia-reperfusion injury on healing of colonic anastomoses. Am J Surg 2002; 184:160-5. [PMID: 12169361 DOI: 10.1016/s0002-9610(02)00908-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antithrombin III is known as the most important natural inhibitor of thrombin activity and has been shown to attenuate local harmful effects of ischemia-reperfusion injury in many organs. In recent animal studies, delaying effect of remote organ ischemia-reperfusion injury on healing of intestinal anastomoses has been demonstrated. In this study, we investigated whether antithrombin III reduces deleterious systemic effects of ischemia-reperfusion injury on healing of colonic anastomoses in rats. METHODS Anastomosis of the left colon was performed in 24 rats that were divided into three groups: sham operated control (group I, n = 8), 30 minutes of intestinal ischemia-reperfusion by superior mesenteric artery occlusion (group II, n = 8), antithrombin III treated group (250 U/kg before and after the ischemia-reperfusion, group III, n = 8). On postoperative day 6, all animals were sacrificed, and bursting pressure and tissue hydroxyproline content of the anastomoses were assessed and compared. RESULTS On postoperative day 6 the mean bursting pressures were 149.6 +/- 4.8, 69.8 +/- 13.5, and 121.8 +/- 8.7 mm Hg for groups I, II, and III, respectively (P = 0.000). Mean tissue hydroxyproline concentration values were 389.5 +/- 29.6, 263.1 +/- 10.0, and 376.0 +/- 33.8 microg/mg for groups I, II, III respectively (P = 0.005). CONCLUSIONS This study showed that, antithrombin III treatment significantly prevented the delaying effect of remote organ ischemia-reperfusion injury on anastomotic healing in the colon. Further clinical studies are needed to clarify whether antithrombin may be a useful therapeutic agent to increase the safety of the anastomosis during particular operations where remote organ ischemia-reperfusion injury takes place.
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Affiliation(s)
- Koray Tekin
- Department of General Surgery, Pamukkale University Medical School, PK-32, 20003, Denizli, Turkey.
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van der Kolk BM, de Man BM, Wobbes T, Hendriks T. Is early post-operative treatment with 5-fluorouracil possible without affecting anastomotic strength in the intestine? Br J Cancer 1999; 79:545-50. [PMID: 10027328 PMCID: PMC2362429 DOI: 10.1038/sj.bjc.6690086] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early post-operative local or systemic administration of 5-fluorouracil (5-FU) is under investigation as a means to improve outcome after resection of intestinal malignancies. It is therefore quite important to delineate accurately its potentially negative effects on anastomotic repair. Five groups (n = 24) of rats underwent resection and anastomosis of both ileum and colon: a control group and four experimental groups receiving daily 5-FU, starting immediately after operation or after 1, 2 or 3 days. Within each group, the drug (or saline) was delivered either intraperitoneally (n = 12) or intravenously (n = 12). Animals were killed 7 days after operation and healing was assessed by measurement of anastomotic bursting pressure, breaking strength and hydroxyproline content. In all cases, 5-FU treatment from the day of operation or from day 1 significantly (P<0.025) and severely suppressed wound strength; concomitantly, the anastomotic hydroxyproline content was reduced. Depending on the location of the anastomosis and the route of 5-FU administration, even a period of 3 days between operation and first dosage seemed insufficient to prevent weakening of the anastomosis. The effects of intravenous administration, though qualitatively similar, were quantitatively less dramatic than those observed after intraperitoneal delivery. Post-operative treatment with 5-FU, if started within the first 3 days after operation, is detrimental to anastomotic strength and may compromise anastomotic integrity.
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Affiliation(s)
- B M van der Kolk
- Department of Surgery, University Hospital Nijmegen, The Netherlands
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Stoop MJ, Dirksen R, Wobbes T, Hendriks T. Effects of early postoperative 5-fluorouracil and ageing on the healing capacity of experimental intestinal anastomoses. Br J Surg 1998; 85:1535-8. [PMID: 9823919 DOI: 10.1046/j.1365-2168.1998.00868.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Results from a previous study suggested that advanced age does not affect early repair of experimental intestinal anastomoses. The present study aimed to establish whether anastomotic healing is impaired more easily in old animals by immediate postoperative chemotherapy. METHODS Young adult (2-3 months) and old (27-30 months) rats underwent resection and anastomosis of both ileum and colon. Within each age group, subgroups received intraperitoneal saline or 5-fluorouracil in a dose of 15 or 20 mg per kg per day from the day of operation onwards. After 7 days, anastomotic healing was assessed by wound strength and collagen deposition in the wound area. RESULTS No differences were found between young and old control groups. The higher dose of fluorouracil induced severe loss of strength with concomitant reduction of wound collagen, which was similar in both age groups (ileum: from 52(13) to 24(8) volume per cent in young animals and from 56(10) to 20(9) volume per cent in old animals; colon: from 58(10) to 37(18) volume per cent in young animals and from 65(5) to 30(17) volume per cent in old animals). The lower dose of fluorouracil induced a significantly greater loss of strength, measured as the bursting pressure, in the old animals (150(49) versus 201(59) mmHg in colon of young rats). CONCLUSION In this model early anastomotic repair in older animals proceeds normally under optimal conditions, but it is more easily disturbed in the presence of fluorouracil.
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Affiliation(s)
- M J Stoop
- Department of Surgery, University Hospital Nijmegen, The Netherlands
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Bostanoğlu S, Dinçer S, Keskin A, Bostanoğlu A, Dursun A, Serim C. Beneficial effect of Iloprost on impaired colonic anastomotic healing induced by intraperitoneal 5-fluorouracil infusion. Dis Colon Rectum 1998; 41:642-8. [PMID: 9593250 DOI: 10.1007/bf02235275] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE 5-Fluorouracil is the most effective chemotherapeutic agent in the management of patients with systemic colorectal cancer. Studies in recent years discussed the gradually increasing benefits of 5-fluorouracil within adjuvant chemotherapy protocols after complete surgical resections. However, many studies also have demonstrated that 5-fluorouracil impairs wound-healing on colonic anastomoses. METHODS In our experimental study, we examined the influence of intraperitoneal 5-fluorouracil on healing of colonic anastomoses and, also, attempted to discover whether Iloprost (PGI2 analog, a potent vasodilator with confirmed cytoprotectivity and inhibitor of thrombocyte aggregation) counteracts impaired wound-healing induced by 5-fluorouracil. A total of 80 Wistar-Albino male rats were separated into four groups. From the day of the operation, Group A received intraperitoneal saline solution, Group B received 20 mg/kg 5-fluorouracil intraperitoneally, Group C received 20 mg/kg 5-fluorouracil plus 2 microg/kg Iloprost intraperitoneally, and Group D received 2 microg/kg Iloprost intraperitoneally. Each group was divided into two subgroups, and both subgroups were killed on the third and seventh postoperative days, respectively. The subjects were measured for anastomose bursting pressures and tissue hydroxyproline levels, and wound-healing was evaluated histopathologically. Statistical evaluations among each group were made with Student's t-test and Pearson's chi-squared tests. RESULTS Iloprost had an accelerating effect on normal colonic anastomose wound-healing histopathologically, had no significant difference on bursting pressures and hydroxyproline levels, and significantly improved the impaired healing effect of 5-fluorouracil. CONCLUSIONS Our study showed a positive effect of Iloprost on the healing of colon anastomosis and, more importantly, if wound-healing is impaired by a chemotherapeutic agent, Iloprost counteracts and reverses the effect. [Key words: 5-Fluorouracil; Healing of colon anastomoses; Iloprost
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Affiliation(s)
- S Bostanoğlu
- 6th Department of Surgery, Ankara Numune Hospital, Turkey
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Kuzu MA, Köksoy C, Kale T, Demirpençe E, Renda N. Experimental study of the effect of preoperative 5-fluorouracil on the integrity of colonic anastomoses. Br J Surg 1998; 85:236-9. [PMID: 9501824 DOI: 10.1046/j.1365-2168.1998.02876.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite curative resection for colorectal cancer, many patients develop recurrence at the primary site or distant organs. These patients are candidates for (neo)-adjuvant chemotherapy. Very little is known about the effect of preoperative 5-fluorouracil (FU) on the healing of colonic anastomoses. The aim of this study was to assess this in a rat model. METHODS Eighty male Wistar rats, weighing 160-215 g, were divided into three groups; (1) a control group underwent left colon resection and primary anastomosis (n = 20); (2) a sham group received 1 ml saline intraperitoneally (n = 30); (3) a study group received 5-FU intraperitoneally (20 mg kg-1). Both saline and 5-FU injections were given intraperitoneally for 5 days before operation. RESULTS There was no difference in the rate of wound complications, intraperitoneal adhesions and anastomotic complications among the groups. Three and seven days after operation, mean bursting pressure of the anastomosis was 36.5 and 198 mmHg in group 1, 34 and 200 mmHg in group 2, and 39 and 190 mmHg in group 3 respectively (P not significant). Although the myeloperoxidase and hydroxyproline content were significantly lower after 5-FU therapy (P < 0.01, compared with others), the clinical outcome was similar. CONCLUSION Preoperative 5-FU consecutive days before operation had no effect on the healing of colonic anastomoses.
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Affiliation(s)
- M A Kuzu
- Department of Surgery, Ankara Numune Hospital, Turkey
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de Waard JW, de Man BM, Wobbes T, van der Linden CJ, Hendriks T. Inhibition of fibroblast collagen synthesis and proliferation by levamisole and 5-fluorouracil. Eur J Cancer 1998; 34:162-7. [PMID: 9624252 DOI: 10.1016/s0959-8049(97)00352-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Experimental studies indicate that anastomotic healing in the intestine is compromised by the immediate postoperative administration of 5-fluorouracil and levamisole. Since fibroblast functions are crucial to healing, we investigated the effects of (combinations of) both drugs on proliferation and collagen synthesis of rat skin fibroblasts in vitro. Proliferation was measured in actively dividing cells by cellular [3H]thymidine uptake and collagen synthesis in non-dividing cells by [3H]proline incorporation into collagenase-digestible protein. 5-Fluorouracil strongly and significantly (P < 0.05) reduced DNA synthesis and collagen synthesis at concentrations of 1 microM or more. The latter effect was not specific for collagen since total protein production was affected similarly. Both effects depended on the duration of exposure to the drugs. Levamisole also inhibited fibroblast proliferation dose-dependently, but less effectively than 5-fluorouracil: 50% inhibition was observed at approximately 0.1 mM. Collagen synthesis was unaffected by levamisole. If levamisole was added together with a low (0.1 microM) concentration of 5-fluorouracil, which in itself did not decrease thymidine incorporation, levamisole's antiproliferative effects became apparent at concentrations as low as 1 microM. A similar effect, but at a much higher concentration (1 mM) was noted on fibroblast collagen synthesis. These results indicate that levamisole potentiates 5-fluorouracil effects in fibroblast cultures and that direct effects of these drugs, alone or in combination, on fibroblast proliferation and collagen synthesis may be responsible for their negative influence on wound repair.
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Affiliation(s)
- J W de Waard
- Department of Surgery, University Hospital Nijmegen, The Netherlands
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Biert J, Wobbes T, Hoogenhout J, de Man B, Hendriks T. Combined preoperative irradiation and direct postoperative 5-fluorouracil without negative effects on early anastomotic healing in the rat colon. Radiother Oncol 1996; 41:257-62. [PMID: 9027942 DOI: 10.1016/s0167-8140(96)01844-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Preoperative irradiation with direct postoperative chemotherapy could benefit patients undergoing surgery for colorectal cancer. This study was designed to examine, in an experimental model, if such treatment is feasible without detrimental effects on early anastomotic healing. MATERIAL AND METHODS A colonic segment was irradiated (25 Gy) in 3 groups (n = 10 each) of male Wistar rats. After 5 days, a colonic resection was performed with anastomotic construction; only the distal limb consisted of irradiated bowel. Postoperatively, animals received daily intraperitoneal 5-fluorouracil (5-FU, group I/CH: 17.5 mg/kg; group I/CL: 12.5 mg/kg) or saline (group I). Three additional groups were treated similarly, but with sham-irradiation: CH, CL and C, respectively. All rats were killed 7 days postoperatively. Parameters measured were: weight, serum albumin and protein, and anastomotic bursting pressure, breaking strength and hydroxyproline content. RESULTS Body weight was diminished significantly in rats receiving chemotherapy. Serum albumin and protein was significantly lower in irradiated groups. At sacrifice, 40% of I/CH rats had functional rectal stenosis. The average bursting pressure (P = 0.0005) and the average breaking strength (P = 0.012) were only reduced significantly in the CH group. The anastomotic hydroxyproline content was significantly higher in the I/CH and I/CL groups vs. the control group. CONCLUSION High-dose direct postoperative 5-FU leads to reduced anastomotic strength. Although the combination of preoperative irradiation (25 Gy) and direct postoperative high-dose 5-FU does not reduce early anastomotic strength, some stenosis may occur. The combination of preoperative irradiation and low-dose 5-FU has no such effect.
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Affiliation(s)
- J Biert
- Department of Surgery, University Hospital Nijmegen, The Netherlands
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27
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de Waard JW, Wobbes T, de Man BM, van der Linden CJ, Hendriks T. The effects of 5-fluorouracil and interferon-alpha on early healing of experimental intestinal anastomoses. Br J Cancer 1996; 74:711-6. [PMID: 8795572 PMCID: PMC2074708 DOI: 10.1038/bjc.1996.426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The continuing search for effective adjuvant therapy after resection of intestinal malignancies has prompted a growing interest in both immediate post-operative regional chemotherapy and the combination of 5-fluorouracil (5-FU) and interferon-alpha as drugs of choice. We have compared the effects of both compounds, alone and together, on early healing of intestinal anastomoses. Four groups (n = 26 each) of rats underwent resection and anastomosis of both ileum and colon: a control group and three groups receiving intraperitoneal 5-FU, interferon-alpha or both on the day of surgery and the next 2 days. Animals were killed 3 or 7 days (n = 10 each) after operation in order to measure anastomotic strength and hydroxyproline content. The remaining six animals in each group were used to study anastomotic collagen synthetic capacity at day 3. Three days after operation, ileal anastomotic bursting pressure was lowered by 37% in the 5-FU/interferon-alpha group (P = 0.0104). At day 7, anastomotic breaking strength was reduced significantly in ileum (P = 0.0221) and colon (P = 0.0054) of the 5-FU/interferon-alpha group and in colon of the interferon-alpha group (P = 0.0221). Collagen synthetic capacity was strongly suppressed by 5-FU but not by interferon-alpha. However, no differences in anastomotic hydroxyproline content were observed between groups at both days 3 and 7. Thus, post-operative use of interferon-alpha, in particular in combination with 5-FU, may be detrimental to anastomotic repair in the intestine.
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Affiliation(s)
- J W de Waard
- Department of Surgery, University Hospital Nijmegen, The Netherlands
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28
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Jacquet P, Stephens AD, Averbach AM, Chang D, Ettinghausen SE, Dalton RR, Steves MA, Sugarbaker PH. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996; 77:2622-9. [PMID: 8640714 DOI: 10.1002/(sici)1097-0142(19960615)77:12<2622::aid-cncr28>3.0.co;2-t] [Citation(s) in RCA: 178] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy (HIIC) was devised and tested to treat such patients. The purpose of this study was to evaluate the morbidity and mortality associated with this treatment approach. METHODS Sixty patients with peritoneal carcinomatosis from adenocarcinoma of the colon or appendix were included in the study. Extensive cytoreductive surgery was combined with heated intraperitoneal mitomycin in an intraoperative lavage technique followed by one cycle of early postoperative intraperitoneal 5-fluorouracil. Eleven clinical variables were selected and statistically correlated with morbidity and mortality. RESULTS Twenty-five complications occurred in 21 patients (morbidity = 35%). Morbidity related to gastrointestinal function included anastomotic leak (n=6), bowel perforations (n=5), bile leak (n=3), and pancreatitis (n=2). Four patients presented with severe hematologic toxicity (Grade 3 or 4). There were three cases of postoperative bleeding, one case of abdominal wound dehiscence, and one case of pulmonary embolism. Morbidity was significantly associated with three clinical factors: male sex, high intraabdominal temperature during HIIC, and duration of the surgical procedure. Enteral complications (bowel fistula and anastomotic leak) occurred in patients with a significantly higher number of peritonectomy procedures and a significantly longer operation. Three patients died within 8 weeks after the procedure (mortality = 5%). Mortality was significantly associated with age and intraabdominal temperature. CONCLUSIONS Cytoreductive surgery combined with HIIC is associated with a 35% morbidity rate and a 5% mortality rate. Extensive surgery (duration and number of peritonectomy procedures) and high intraabdominal temperature represent the major risk factors for postoperative morbidity and mortality of patients treated with this new therapeutic approach.
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Affiliation(s)
- P Jacquet
- The Washington Cancer Institute, Washington Hospital Center, Washington, D.C. 20010, USA
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29
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Ettinghausen SE, Averbach AM. Adjuvant hyperthermic intraperitoneal chemotherapy for adenocarcinoma of the pancreas. Cancer Treat Res 1996; 81:227-37. [PMID: 8834588 DOI: 10.1007/978-1-4613-1245-1_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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30
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de Waard JW, Wobbes T, de Man BM, van der Linden CJ, Hendriks T. Post-operative levamisole may compromise early healing of experimental intestinal anastomoses. Br J Cancer 1995; 72:456-60. [PMID: 7640232 PMCID: PMC2034010 DOI: 10.1038/bjc.1995.355] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
There exists growing interest in immediate post-operative local adjuvant therapy after resection of intestinal malignancies. It is therefore necessary to assess it potential effect on the healing of intestinal anastomoses. Five groups (n = 20) of rats underwent resection and anastomosis of both ileum and colon: a control group and four experimental groups receiving intraperitoneal 5-fluorouracil (5-FU), 5-FU plus leucovorin, 5-FU plus levamisole or levamisole alone, on the day of surgery and the next 2 days. Animals were killed 3 or 7 days after operation. Another three groups (n = 6) of animals were used to compare anastomotic collagen synthetic capacity in control rats or rats receiving 5-FU or 5-FU plus levamisole. On the third post-operative day, the average anastomotic bursting pressure in the 5-FU/levamisole group was reduced by 36% as compared with the control group, both in ileum (P = 0.02) and in colon (P = 0.01). Values in the other groups were similar to those in the control group. Anastomotic breaking strength was significantly (P < 0.025) lowered in the ileum from the levamisole group at both days 3 and 7. Anastomotic collagen synthetic capacity was strongly reduced in the 5-FU and 5-FU/levamisole groups. However, there was no significant difference between the control group and the four experimental groups with regard to anastomotic hydroxyproline concentration and content, either 3 or 7 days after operation. Thus, limited use of levamisole, alone or in combination with intraperitoneal 5-FU, may compromise intestinal healing.
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Affiliation(s)
- J W de Waard
- Department of Surgery, University Hospital Nijmegen, The Netherlands
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31
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Abstract
PURPOSE To summarize the most current information about the etiology, pathophysiology, clinical presentation, treatment, and outcome of esophagogastrostomy leaks following esophagectomy. METHOD The English language literature was searched by manual methods and MEDLINE for original articles reporting results and complications of esophagectomy. RESULTS Esophagogastrostomy anastomotic leaks cause considerable morbidity and mortality after esophagectomy. Their major etiologic factors are ischemia of the gastric fundus and errors in surgical technique. The clinical presentation of postoperative anastomotic leak ranges from an asymptomatic radiographic finding to a necrotizing thoracic infection. Severity of illness is largely dependent on four factors: gastric viability, the site (thorax or neck) and time of the leak, and its containment by surrounding tissues. Cervical anastomoses have a higher leak rate than thoracic anastomoses, but leaks from thoracic anastomoses are more morbid. CONCLUSION Leaks from thoracic anastomoses require aggressive surgical treatment. Cervical anastomotic leaks that are truly confined to the neck can usually be managed at the bedside with wound drainage and packing. However, the seriousness of cervical anastomotic leaks should not be underestimated. Some leaks from anastomoses constructed in the neck are, in reality, mediastinal leaks. Selected patients with radiologically detected asymptomatic leaks can be managed conservatively.
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Affiliation(s)
- J D Urschel
- Division of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA
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32
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Weiber S, Graf W, Glimelius B, Jiborn H, Påhlman L, Zederfeldt B. Experimental colonic healing in relation to timing of 5-fluorouracil therapy. Br J Surg 1994; 81:1677-80. [PMID: 7827906 DOI: 10.1002/bjs.1800811140] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In an experimental study resembling clinical use of adjuvant 5-fluorouracil (5-FU) treatment of colorectal carcinoma, 97 male Wistar rats were operated on with a standardized left colonic resection. Treatment was given as a daily intraperitoneal injection. The animals were randomized to one of four groups: early treatment with 5-FU 20 mg/kg or saline 0.1 mol/l from the day of operation to day 7 after operation, and delayed treatment with 5-FU 20 mg/kg or saline 0.1 mol/l from the third day after operation to the day before killing. The animals were killed in groups on day 7 or 10 after operation. In the group receiving early 5-FU treatment there was an increased rate of anastomotic complications (seven of 26) compared with none in the control or delayed 5-FU groups. The anastomotic breaking strength in animals having early 5-FU treatment (day 7, median 1.45 (range 0.20-2.95) N; day 10, median 1.80 (range 0.95-3.20) N) was significantly lower than that in controls on both day 7 (median 3.20 (range 2.50-3.80)N) and day 10 (median 3.20 (range 2.20-3.60)N). In the delayed 5-FU treatment group anastomotic breaking strength did not differ from that in controls. Colonic healing was not impaired when intraperitoneal 5-FU treatment was started on day 3 after operation, whereas immediate postoperative administration of 5-FU had a detrimental effect on wound healing.
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Affiliation(s)
- S Weiber
- Department of Surgery, Allmänna sjukhuset, Malmö, Sweden
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33
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Graf W, Westlin JE, Påhlman L, Glimelius B. Adjuvant intraperitoneal 5-fluorouracil and intravenous leucovorin after colorectal cancer surgery: a randomized phase II placebo-controlled study. Int J Colorectal Dis 1994; 9:35-9. [PMID: 8027622 DOI: 10.1007/bf00304298] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fifty patients were randomized to receive adjuvant intraperitoneal 5-fluorouracil (5-FU, 500 mg/m2/day) and intravenous leucovorin (60 mg/m2/day) and 51 to receive placebo after curative surgery for colorectal cancer. Treatment started on the day after surgery and continued for 6 days. One case of stomatitis, one of leucopenia and one case of abnormal liver function tests were the only chemotherapy-related toxic effects. From the second day of treatment, pain during intraperitoneal infusions occurred more frequently in the 5-FU group, although statistical significance was only attained on day 2 (P < 0.05). The groups did not differ substantially regarding any other adverse effects, the incidence of surgical complications, second laparotomies, time from surgery to discharge, or premature treatment terminations. The postoperative course after intraperitoneal 5-FU and intravenous leucovorin was thus not more complicated than that in patients treated with placebo. The tolerance was acceptable and chemotherapy-related toxicity was rare. Thus important prerequisites exist for more widespread use of the present regimen in order to evaluate its impact on survival.
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Affiliation(s)
- W Graf
- Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden
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34
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de Waard JW, Wobbes T, Hendriks T. Early post-operative 5-fluorouracil does not affect the healing of experimental intestinal anastomoses. Int J Colorectal Dis 1993; 8:175-8. [PMID: 8245676 DOI: 10.1007/bf00341194] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
5-Fluorouracil (5-FU) remains the mainstay for systemic treatment of colorectal cancer. In view of the increasing interest in peri-operative administration of antineoplastic agents, we have investigated the effects of early postoperative 5-FU on the healing of intestinal anastomoses in the rat. Animals underwent resection and anastomosis of both ileum and colon and 5-FU (20 mg/kg body weight) was given, either intravenously or intraperitoneally, on the day of surgery and the two subsequent days. Healing was assessed three and seven days after operation. Administration of 5-FU led to a reduced white blood cell count. However, anastomotic strength was not significantly reduced at either time point and anastomotic hydroxyproline content was not significantly affected. We suggest that limited use of 5-FU during or immediately after operation does not necessarily affect early anastomotic healing in the intestine.
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Affiliation(s)
- J W de Waard
- Department of General Surgery, University Hospital, St Radboud, Nijmegen, The Netherlands
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35
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Hendricks T, Martens MF, Huyben CM, Wobbes T. Inhibition of basal and TGF beta-induced fibroblast collagen synthesis by antineoplastic agents. Implications for wound healing. Br J Cancer 1993; 67:545-50. [PMID: 7679921 PMCID: PMC1968243 DOI: 10.1038/bjc.1993.100] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Antineoplastic drugs, given in the perioperative period, are thought to be a hazard to wound repair. Since fibroblast collagen synthesis is crucial to healing, we examined the effects of bleomycin, cisplatin and 5-fluorouracil on collagen synthesis in confluent cultures of fibroblasts from human colon and skin. The drugs were added in final concentrations between 0.1 and 50 microM. Bleomycin did not affect collagen synthesis in colon fibroblasts but inhibited synthesis in skin fibroblasts. Collagen synthesis in colon fibroblasts was strongly, and specifically, inhibited by cisplatin while synthesis in skin fibroblasts was affected only slightly. 5-Fluorouracil had no effect whatsoever on the collagen synthetic capacity in either colon or skin fibroblasts. If skin fibroblasts were cultured in the presence of transforming growth factor beta (TGF beta), the antineoplastic agents inhibited the TGF beta-stimulated collagen synthesis at far lower concentrations than those needed to suppress non-stimulated synthesis. This effect was not observed in fibroblasts from colon. The possible implications of these observations, as pertain to the use of perioperative chemotherapy, are discussed. Since 5-fluorouracil did not directly affect collagen synthesis in colon fibroblasts under any of the conditions tested it is suggested that the data support the contention that this drug is relatively harmless for intestinal healing.
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Affiliation(s)
- T Hendricks
- Department of General Surgery, University Hospital Nijmegen, The Netherlands
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