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Nunes VRT, Vidigal PVT, Pereira MT, Ladeira LCD, Caliari MV, Oliveira FMS, Cesar ALA, Faraco AAG, Barbuto RC, Duval-Araujo I. Evaluation of mesalazine polymeric conjugate in the treatment of actinic proctitis in rats. Acta Cir Bras 2021; 36:e360805. [PMID: 34644773 PMCID: PMC8516428 DOI: 10.1590/acb360805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/24/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: The present study aimed at testing a new formulation of mesalazine linked to
chondroitin sulfate and its components alone in the treatment of actinic
proctitis in rats. Methods: Forty-seven female Wistar rats were submitted to pelvic radiation and divided
into eight groups: control A, mesalazine A, chondroitin A, and conjugate A,
gavage of the according substance two weeks after irradiation and sacrifice
three weeks after oral treatment; control C, mesalazine C, chondroitin C,
and conjugate C, sacrifice six weeks after oral treatment. The rectum was
submitted to histological characterization for each of the findings:
inflammatory infiltrate, epithelial degeneration, mucosal necrosis, and
fibrosis. Results: The inflammatory infiltrate was more intense in chondroitin A, mesalazine A,
and conjugate C. The collagen deposition was less intense in chondroitin A,
and mesalazine A, and more intense in control C. Conclusions: Mesalazine and chondroitin alone were efficacious in inducing a delayed
inflammatory response, hence reducing the late fibrosis. The conjugate was
able to induce an ever more delayed inflammatory response.
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Sparreboom CL, Wu Z, Lingsma HF, Menon AG, Kleinrensink GJ, Nuyttens JJ, Wouters MWJM, Lange JF. Anastomotic Leakage and Interval between Preoperative Short-Course Radiotherapy and Operation for Rectal Cancer. J Am Coll Surg 2018; 227:223-231. [DOI: 10.1016/j.jamcollsurg.2018.03.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/12/2022]
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Stansborough RL, Al-Dasooqi N, Bateman EH, Bowen JM, Keefe DMK, Logan RM, Yeoh ASJ, Yeoh EEK, Stringer AM, Gibson RJ. Matrix metalloproteinase expression is altered in the small and large intestine following fractionated radiation in vivo. Support Care Cancer 2018; 26:3873-3882. [PMID: 29754212 DOI: 10.1007/s00520-018-4255-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 05/06/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Radiotherapy-induced gut toxicity (RIGT) is associated with significant diarrhoea, pain and rectal bleeding. Matrix metalloproteinases (MMPs) have been reported to be involved in chemotherapy-induced gut toxicity and RIGT following single-dose irradiation in vivo. We therefore proposed MMPs would be involved in the pathobiology of RIGT following fractionated irradiation. METHODS Dark Agouti rats were treated with fractionated radiation (3 × 2.5 Gy/week for 6 weeks). Rats were killed at 3, 6 and 15 weeks to represent acute and chronic toxicities. Sections of jejunum and colon were immunostained for MMP-1, MMP-2, MMP-9 and MMP-14. Relative mRNA expression in jejunum and colon was quantified by RT-PCR for MMP-1, MMP-2, MMP-9 and MMP-14. Western blotting was also conducted on jejunum and colon tissue collected at week 6 to determine protein levels of pro- and active MMP-2. RESULTS MMP-2 total protein levels, determined by western blotting, significantly increased in both the jejunum (p = 0.0359) and the colon (p = 0.0134) 6 weeks into the fractionated radiation schedule. MMP-1, MMP-2, and MMP-14 mRNA expression significantly increased in the jejunum. MMP-2 mRNA expression was also significantly increased in the colon. Immunostaining of MMP-2 was observed to be increased in both crypt enterocytes and the lamina propria. CONCLUSIONS MMP-2 plays a role in the pathobiology of gastrointestinal toxicities following fractionated irradiation. Whilst MMP-1 and MMP-14 mRNA expression was increased, this occurred only in the jejunum, suggesting MMPs are differentially involved in RIGT depending on the intestinal region. Further studies are needed to elucidate the role these mediators play in the development and potentiation of RIGT.
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MESH Headings
- Animals
- Dose Fractionation, Radiation
- Dose-Response Relationship, Radiation
- Female
- Gastrointestinal Diseases/etiology
- Gastrointestinal Diseases/genetics
- Gene Expression Regulation, Enzymologic/radiation effects
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/pathology
- Intestinal Mucosa/radiation effects
- Intestine, Large/metabolism
- Intestine, Large/pathology
- Intestine, Large/radiation effects
- Intestine, Small/metabolism
- Intestine, Small/pathology
- Intestine, Small/radiation effects
- Matrix Metalloproteinases/genetics
- Matrix Metalloproteinases/metabolism
- Radiation Dosage
- Radiation Injuries/genetics
- Radiation Injuries/pathology
- Rats
- Rats, Transgenic
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Affiliation(s)
- Romany L Stansborough
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia.
| | - Noor Al-Dasooqi
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Emma H Bateman
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Joanne M Bowen
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Dorothy M K Keefe
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Richard M Logan
- Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Ann S J Yeoh
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Eric E K Yeoh
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Andrea M Stringer
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Rachel J Gibson
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
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Nunes VRT, Vidigal PVT, Pereira MT, Ladeira LCD, Barbuto RC, Duval-Araujo I. Development of a new model of actinic enteritis in rats using a cobalt-60 open source and a protection device as a collimator. Acta Cir Bras 2017; 32:319-324. [DOI: 10.1590/s0102-865020170040000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 12/23/2022] Open
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Cho Y, Chang JS, Kim MS, Lee J, Byun H, Kim N, Park SJ, Keum KC, Koom WS. Morphologic change of rectosigmoid colon using belly board and distended bladder protocol. Radiat Oncol J 2015; 33:134-41. [PMID: 26157683 PMCID: PMC4493425 DOI: 10.3857/roj.2015.33.2.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/15/2015] [Accepted: 05/20/2015] [Indexed: 12/18/2022] Open
Abstract
Purpose This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. Materials and Methods Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. Results Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). Conclusion Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.
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Affiliation(s)
- Yeona Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mi Sun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | | | - Hwakyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Nalee Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sang Joon Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Ki Chnag Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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Nisar PJ, Lavery IC, Kiran RP. Influence of neoadjuvant radiotherapy on anastomotic leak after restorative resection for rectal cancer. J Gastrointest Surg 2012; 16:1750-7. [PMID: 22744637 DOI: 10.1007/s11605-012-1936-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/15/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection. METHODS From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors within 15 cm of anal verge) were identified from a prospective institutional database and grouped based on whether they received neoadjuvant radiotherapy (+RT) or not (-RT). The main outcome was anastomotic leak documented by imaging (contrast leak), intra-operative or clinical (signs of peritonitis) findings and confirmed by staff surgeon assessment. Using multivariate (MV) analysis risk factors for leak were identified, presented as OR (95 % CI). RESULTS One thousand eight hundred sixty-two patients were included in the analysis, 28 % in the +RT group. Eighty-six percent of +RT patients received neoadjuvant chemoradiotherapy. The overall leak rate was 6.3 %, with no significant difference in +RT and -RT groups (8 % vs 5.7 %, p = 0.06). The +RT group had a lower mean age at surgery (58 vs 63 year, p < 0.001), more male (75 % vs 62 %, p < 0.001) and more ASA 3/4 (44 % vs 35 %, p < 0.001) patients, greater use of defunctioning ostomy (87 % vs 44 %, p < 0.001) and colo-anal anastomosis (77 % vs 34 %, p < 0.001). Mean tumor distance from the anal verge was lower in +RT group (6.6 vs 9.7 cm, p < 0.001). On MV analysis, male sex (OR 1.64 (1.03-2.62), p = 0.038), ASA 4 (OR 4.70 (2.07-10.7), p < 0.001), tumor distance from anal verge ≤ 5 cm (OR 2.49 (1.37-4.52), p = 0.003), and tumor size at surgery ≥ 4 cm (OR 1.75 (1.15-2.65), p = 0.009) were independently associated with leak. +RT was not independently associated with leak (OR 1.44 (0.85-2.46), p = 0.18), while defunctioning ostomy did not reduce leak occurrence (OR 0.75 (0.44-1.28), p = 0.29). CONCLUSIONS The findings suggest that neoadjuvant radiotherapy is not independently associated with an anastomotic leak for rectal cancer patients undergoing restorative resection and support a selective policy towards the use of a defunctioning ostomy on a case by case basis based on intra-operative judgment and consideration of tumor location, size, and patient characteristics.
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Affiliation(s)
- Pasha J Nisar
- Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Demir EO, Cakmak GK, Bakkal H, Turkcu UO, Kandemir N, Demir AS, Tascılar O. N-acetyl-cysteine improves anastomotic wound healing after radiotherapy in rats. J INVEST SURG 2011; 24:151-8. [PMID: 21675850 DOI: 10.3109/08941939.2011.560237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM This study was designed to determine the effects of intraperitoneally or orally administered N-acetylcysteine (NAC) on anastomotic healing of irradiated rats. METHODS Thirty-two male Wistar albino rats were randomized into four groups containing 8 rats each: I; standard resection plus anastomosis, II; radiation plus standard resection plus anastomosis, III; radiation plus standard resection plus anastomosis plus oral NAC, IV; radiation plus standard resection plus anastomosis plus intraperitoneal NAC. Four types of assessment were performed: bursting pressure, hydroxiproline (OHP) content, histopathology, and biochemical evaluation, including serum malondialdehyde (MDA), advanced oxidation protein products (AOPP), reduced glutathione (GSH) and superoxide dismutase (SOD) activities. RESULTS Group comparisons demonstrated that bursting pressure was significantly higher in NAC treated rats. The mean tissue OHP concentration in the anastomotic tissue was significantly lower in irradiated rats (group II) than in the other groups. NAC treatment caused increased activity of SOD and GSH. In contrast, MDA levels were found to be decreased in groups III and IV. Histopathological analysis revealed that NAC administration, either orally or intraperitoneally, leads to a better anastomotic healing in terms of reepithelialization, perianastomotic fibrosis, ischemic necrosis, and muscle layer destruction. CONCLUSION The present study supports the hypothesis that NAC administration alleviates the negative effects of radiotherapy on anastomotic healing. Nevertheless, the underlying mechanisms responsible for this protective effect is unknown today.
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Affiliation(s)
- Ebru Ofluoglu Demir
- Department of Health Programmes, Zonguldak Karaelmas University, Ahmet Erdogan Vocational School of Health Services, Zonguldak, Turkey.
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Effects of oxidative stress on mitochondrial content and integrity of human anastomotic colorectal dehiscence: a preliminary DNA study. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:433-9. [PMID: 21912768 DOI: 10.1155/2011/741073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anastomotic dehiscence is one of the most severe complications of colorectal surgery. Gaining insight into the molecular mechanisms responsible for the development of anastomotic dehiscence following colorectal surgery is important for the reduction of postoperative complications. OBJECTIVE Based on the close relationship between surgical stress and oxidative stress, the present study aimed to determine whether a correlation exists between increased levels of reactive oxygen species and colorectal anastomotic dehiscence. METHODS Patients who underwent surgical resection for colorectal cancer were divided into three groups: patients with anastomotic dehiscence (group 1); patients without dehiscence who underwent neoadjuvant radiochemotherapy (group 2); and patients without anastomotic dehiscence who did not undergo neoadjuvant radiochemotherapy (group 3). Quantitative polymerase chain reaction and real-time polymerase chain reaction assays were performed to measure nuclear DNA and mitochondrial DNA (mtDNA) content, and possible oxidative damage to nonmalignant colon and rectal tissues adjacent to the anastomoses. RESULTS mtDNA content was reduced in the colon tissue of patients in groups 1 and 2. Rectal mtDNA was found to be more damaged than colonic mtDNAs in all groups. The 4977 bp common deletion was observed in the mtDNA of tissues from both the colon and rectum of all patients. DISCUSSION Patients in groups 1 and 2 were more similar to one another than to group 3, probably due to higher levels of reactive oxygen species in the mitochondria; the greater damage found in the rectum suggests that dehiscence originates primarily from the rectal area. CONCLUSIONS The present study of mtDNA analyses of normal human colon and rectal tissues from patients with colorectal cancer is among the first of its kind.
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Delabio-Ferraz E, Aguiar Neto JPD, Takiya CM, Lacombe DP. Rana catesbeiana, pólvora e modulação supramolecular cicatrização intestinal e prognóstico no câncer de cólon: uma mesma origem biológica para o insucesso? ACTA ACUST UNITED AC 2010. [DOI: 10.1590/s0101-98802010000200004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A cicatrização e remodelação do cólon resultam das modificações do colágeno na matriz extracelular. Algumas condições desequilibram sua renovação, enfraquecendo a resistência mecânica a cicatriz, como resultado da atividade elevada das metaloproteinases locais, e levando a um alto risco de deiscência. As metaloproteinases da matriz extracelular (matrix metalloproteinases, MMPs) constituem uma família de endopeptidases zinco-dependentes - metzincinas. São reconhecidos atualmente, em humanos, cerca de 24 genes responsáveis por cada uma delas. A colagenase (MMP-1) foi identificada por Gross e Lapière (1962) na cauda do girino da rã-touro americana. No câncer as MMPs tem ocupado um lugar especial. Evidências de que a célula neoplásica é capaz de interferir na modulação desta enzima - um co-fator associado à invasividade local e disseminação metastática. As MMP-2 e -7 são observadas com frequência no câncer de cólon, a MMP-12 parece exercer um efeito protetor (melhor prognóstico) e, ao contrário, a MMP-3 o torna pior. A associação entre alta atividade de MMPs, o pior prognóstico do câncer e o maior risco de deiscência de anastomose intestinal já vem sendo considerada, sugerindo uma trilogia consistente. A terapia farmacológica (inibidores MMPs) tem sido investigada, também para o controle do câncer. O artigo discute as informações mais relevantes e atualizadas sobre o assunto.
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Bedirli A, Salman B, Pasaoglu H, Ofluoglu E, Sakrak O. Effects of nuclear factor-κB inhibitors on colon anastomotic healing in rats. J Surg Res 2010; 171:355-60. [PMID: 20605167 DOI: 10.1016/j.jss.2010.01.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 01/05/2010] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nuclear factor (NF)-κB plays an essential role in inflammation. We tested this role by administering NF-κB-inhibitors into rats undergoing a well-established model of colonic anastomotic healing. METHODS Wistar rats underwent laparotomy, descending colonic transection, and handsewn reanastomosis. The animals were randomized to receive either a selective NF-κB inhibitor (parthenolide 0.5 mg/kg or resveratrol 0.5 mg/kg) or an equal volume of water by gavages before operation and then daily after surgery. Animals were sacrificed either immediately after anastomotic construction (d 0) or at the third, fifth, or seventh postoperative day. RESULTS Both parthenolide and resveratrol treatment led to early significant increases in plasma levels of IL-6. On d 7, hydroxyproline levels were significantly higher in the parthenolide and resveratrol groups. A similar pattern was observed with the bursting pressure. In contrast, gelatinase activity (MMP-2 and MMP-9 expression) was significantly higher in the control group on postoperative d 3. On d 3, expression of NF-κB activity was up-regulated in the anastomotic area. Both parthenolide and resveratrol completely attenuated NF-κB activity. Study groups also developed more marked inflammatory cell infiltration and collagen deposition on histology analysis. CONCLUSIONS Parthenolide and resveratrol significantly improved healing and mechanical stability of colonic anastomoses in rats during the early postoperative period. Both agents may be acting to accelerate the host reparative process as well as to enhance protection of the anastomotic wound bed.
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Affiliation(s)
- Abdulkadir Bedirli
- Department of General Surgery, Gazi University Medical School, Ankara, Turkey.
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Karliczek A, Zeebregts CJ, Benaron DA, Coppes RP, Wiggers T, van Dam GM. Preoperative irradiation with 5 x 5 Gy in a murine isolated colon loop model does not cause anastomotic weakening after colon resection. Int J Colorectal Dis 2008; 23:1115-24. [PMID: 18629517 DOI: 10.1007/s00384-008-0507-z] [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] [Accepted: 05/29/2008] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There are conflicting studies on the influence of fractionated preoperative 5 days of 5 Gy irradiation on tissue oxygenation and subsequent colonic anastomotic strength. To elucidate the effect of preoperative irradiation on anastomotic strength, an isolated colon loop model was developed. METHODS Male Wistar rats (n = 164) were randomly divided into three groups. One group remained untreated (control). In the other two groups, a loop of descending colon was exteriorized to create a hernia of the abdominal wall. After 4 weeks' recovery, this loop was locally irradiated with 5 x 5 Gy of gamma-rays or sham irradiated. One week after (sham-) irradiation, an anastomosis was performed in all groups. Tissue oxygenation (StO2) was determined with visible light spectroscopy. The animals were sacrificed 3 or 7 days after the operation and the anastomosis was tested for bursting pressure and breaking strength. RESULTS Irradiated rats showed significantly more weight loss (90% SD 4.3 of initial body weight vs. 96% SD 2.8, p < or = 0.05) and enteritis (18% vs. 5%, p = 0.013) compared to sham and control animals. StO2 was not influenced by irradiation and was not predictive for anastomotic strength. The control group showed significantly lower bursting pressure and breaking strength compared to (sham-) irradiated animals. CONCLUSION We developed a new isolated loop model for intermittent irradiation of the colon. Preoperative irradiation of the distal part of a colon anastomosis was successfully administered with acceptable side effects and did not cause reduced tissue oxygenation nor clinical signs of anastomotic weakening, nor objective reduction in bursting pressure and breaking strength.
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Affiliation(s)
- A Karliczek
- Department of Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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