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Intraperitoneal heated chemotherapy affects healing of experimental colonic anastomosis: An animal study
Author(s) -
Makrin V.,
LevChelouche D.,
Even Sapir E.,
Paran H.,
Rabau M.,
Gutman M.
Publication year - 2004
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20161
Subject(s) - medicine , anastomosis , chemotherapy , mitomycin c , saline , intraperitoneal chemotherapy , surgery , hyperthermia , gastroenterology , cancer , ovarian cancer
Background The peritoneal spread of cancer is a well‐known entity carrying a dismal prognosis. A new therapeutic approach is the combination of cytoreduction with heated intraperitoneal chemotherapy (HIPC). The risk of an intra‐abdominal anastomosis in the presence of such chemotherapy is recognized clinically but the experimental data on the subject are lacking. The aim of this study is to examine the influence of chemotherapy and hyperthermia on the healing of colonic anastomosis. Materials and Methods Colonic anastomosis were performed in four groups of male Wistar rats: (1) control (operation only), (2) HIPC with saline, (3) with mitomycin C (MMC), and (4) with cisplatinum. HIPC was performed using a closed circulation system at 40°C over 20 min. Anastomotic strength was tested on day 4, 7, 10, and 21. Results The bursting pressure of anastomoses in rats treated by HIPC was significantly lower than in controls. On day 4, it was 54.8 mm Hg, 38 mm Hg, 18 mm Hg, and 14.8 mm Hg in groups 1–4, respectively, while on day 7 it was 170 mm Hg, 188 mm Hg, 83 mm Hg, and 19 mm Hg, respectively ( P < 0.01). The difference decreased on day 10 and almost vanished on day 21. HIPC with cisplatinum had the worst effect on anastomotic healing during the early postoperative period. Conclusions Cytoreduction and HIPC are gaining popularity. However, the use of heated chemotherapy has a detrimental effect on the strength of colonic anastomosis, especially during the early postoperative period (until day 10). This may cause anastomotic failure and postoperative morbidity. Therefore, careful selection and avoidance of unnecessary anastomoses are mandatory. J. Surg. Oncol. 2005;89:18–22. © 2004 Wiley‐Liss, Inc.