Effect of fibrin sealant on perianastomotic tumor growth in an experimental model of colorectal cancer surgery

VIVOSTAT ® SYSTEM AS A METHOD OF PREVENTING ANASTOMOTIC LEAKAGE FOLLOWING LOW ANTERIOR RECTAL RESECTION: CLINICAL CASE

Background: According to current literature, anastomosis leakage holds a leading position among all complications of colorectal surgery. A particular area of prevention of this complication in colorectal oncology is the research of the possibilities of using biological adhesive compounds as a universal biological and mechanical barrier to the spread of intraluminal microflora and tumor cells.

Clinical case: A 65-year-old patient (female) was hospitalized with a diagnosis of rectal cancer cT3cN1cM0 (stage III) after neoadjuvant chemoradiotherapy. Surgical treatment was performed: the laparoscopic low anterior resection of the rectum with expanded lymphodissection, protective loop ileostomy. The anastomosis was formed at a height of 4 cm from the anus. Intraoperatively, the anastomosis line was strengthened using the Vivostat R system product. The technology of on-site preparation and application of the compound is described in the paper.. The postoperative period passed without complications.

Conclusion: Due to the possible economic, oncological and postoperative advantages, the use of modern fibrin adhesive compositions is quite promising for introduction into surgical practice. It is required to conduct research aimed at studying the effectiveness of this method of preventing the leakage of colorectal anastomoses.

Fibrinogen and thrombin concentrations are critical for fibrin glue adherence in rat high-risk colon anastomoses

OBJECTIVE

Fibrin glues have not been consistently successful in preventing the dehiscence of high-risk colonic anastomoses. Fibrinogen and thrombin concentrations in glues determine their ability to function as sealants, healers, and/or adhesives. The objective of the current study was to compare the effects of different concentrations of fibrinogen and thrombin on bursting pressure, leaks, dehiscence, and morphology of high-risk ischemic colonic anastomoses using fibrin glue in rats.

METHODS

Colonic anastomoses in adult female Sprague-Dawley rats (weight, 250-350 g) treated with fibrin glue containing different concentrations of fibrinogen and thrombin were evaluated at post-operative day 5. The interventions were low-risk (normal) or high-risk (ischemic) end-to-end colonic anastomoses using polypropylene sutures and topical application of fibrinogen at high (120 mg/mL) or low (40 mg/mL) concentrations and thrombin at high (1000 IU/mL) or low (500 IU/mL) concentrations.

RESULTS

Ischemia alone, anastomosis alone, or both together reduced the bursting pressure. Glues containing a low fibrinogen concentration improved this parameter in all cases. High thrombin in combination with low fibrinogen also improved adherence exclusively in low-risk anastomoses. No differences were detected with respect to macroscopic parameters, histopathology, or hydroxyproline content at 5 days post-anastomosis.

CONCLUSIONS

Fibrin glue with a low fibrinogen content normalizes the bursting pressure of high-risk ischemic left-colon anastomoses in rats at day 5 after surgery.

Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: case-control study using propensity score matching method

BACKGROUND

The oncologic impact of anastomotic leakage after rectal cancer surgery remains controversial.

METHODS

Between January 1999 and December 2010, 1,148 patients with rectal cancer who underwent curative surgery with sphincter preservation were retrospectively reviewed. Using the propensity score matching method, 328 patients with fibrin glue were matched to 328 patients without fibrin glue, and oncologic outcomes were compared in the matched groups.

RESULTS

Anastomotic leakage was diagnosed in 76 patients (6.6%). On multivariate analysis, fibrin glue was the independent predictor of prevention of anastomotic leakage. In the 656 matched groups, patients with anastomotic leakage had significantly worse 5-year local recurrence-free survival and disease-free survival than those without leakage. Multivariate analysis confirmed that anastomotic leakage was an independent prognostic factor of both local recurrence and disease-free survival, but the use of fibrin glue was not associated with the long-term outcomes when controlling for confounders.

CONCLUSIONS

Anastomotic leakage is a major independent prognostic factor for long-term outcomes. Fibrin glue has a protective effect of anastomosis, without oncologic advantages.

Estudo morfológico das entero-anastomoses com suturas em pontos separados complementados com adesivo sintético ou biológico em coelho

OBJETIVO: Verificar a eficácia dos adesivos de fibrina e cianoacrilato como coadjunvantes nas anastomoses de intestino delgado de coelhos. MÉTODOS: Oitenta coelhos, linhagem Nova Zelândia, machos, adultos, foram submetidos a enterectomia de 3cm e enterorrafia e distribuídos em quatro grupos: Grupo A (dois pontos eqüidistantes); Grupo B (quatro pontos eqüidistantes); Grupo C (seis pontos eqüidistantes); Grupo D (oito pontos eqüidistantes). No 14º dia de observação, os animais foram submetidos a uma laparotomia mediana para estudo macroscópico da cavidade abdominal para identificação e avaliação de aderências, deiscências e/ou fístulas. O segmento intestinal anastomosado foi retirado e feito um molde de alginato para posterior avaliação do índice de estenose. As peças retiradas foram processadas para estudo histológico e avaliação de fibras colágenas, macrófagos, neovascularização e granuloma tipo corpo estranho. RESULTADOS: Não houve diferença significante na avaliação de deiscência e fístulas com os dois adesivos entre os quatros sub-grupos. A aderência ocorreu em maior número nos sub-grupos do adesivo sintético. O índice de estenose foi maior nos animais do adesivo sintético somente nos sub-grupos com dois e oito pontos. A análise histológica mostrou que em todos os parâmetros avaliados (macrófago, neovascularização e granuloma) não houve diferença significante entre os dois tipos de adesivos. Em relação a porcentagem de colágeno verificou-se que houve diferença significante somente no grupo B em que o adesivo sintético foi menor que o biológico. CONCLUSÃO: O adesivo biológico de fibrina mostra mais eficácia que o adesivo sintético como complemento de suturas nas anastomoses intestinais.

An experimental evaluation of three preoperative radiation regimens for resectable rectal cancer

BACKGROUND

We investigated the degree of tumor cell killing after radiotherapy regimens commonly used in clinical practice in comparison with an accelerated schedule.

METHODS

Mtln3 mammary adenocarcinoma tumor cells were inoculated subcutaneously in the hind leg of syngeneic Fischer 344 rats. Tumors were irradiated with 5 x 5 Gy in 5 days, 10 x 3 Gy over 10 days, or 5 x (2 x 3) Gy in 5 days. After excision of the irradiated tumors, the dye exclusion, a tetrazolium-based colorimetric and the clonogenic assays were used to determine tumor cell viability and surviving fractions.

RESULTS

Estimated potential doubling time values indicate a rapid proliferation capacity, comparable with potential doubling time values in human rectal cancer. The dye exclusion and clonogenic assays revealed a significantly higher degree of cell killing after the hypofractionated and the accelerated regimens of, respectively, 5 x 5 Gy and 5 x (2 x 3) Gy over 5 days compared with 10 x 3 Gy over 10 days.

CONCLUSIONS

A shorter treatment time offered the best therapeutic efficacy. The schedule involving two daily fractions of 3 Gy over 5 days should be less toxic than 5 x 5 Gy and may therefore provide a therapeutic advantage.