Intraperitoneal heated chemotherapy affects healing of experimental colonic anastomosis: An animal study

Makrin, Vadim; Lev-Chelouche, Dina; Sapir, Einav; Paran, Haim; Rabau, Micha; Gutman, Mordechai

doi:10.1002/jso.20161

Cited by 40 publications

(33 citation statements)

References 24 publications

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“…However, they presented 3 times higher risk of developing a GIII–IV postoperative complication compared with those who were submitted to IPHP with a lower CDDP dose, when adjusted for the other variables. This finding, at first glance, should not be surprising as it can be supported by an experimental study, which demonstrated the negative influence of CDDP on healing of bowel anastomosis after IPHP 18. In addition, the digestive complications due to anastomotic leaks and/or bowel perforations were the most frequent type of major morbidity in the present series, as already discussed.…”

Section: Discussionsupporting

confidence: 87%

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Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion

Kusamura

Younan

Baratti³

et al. 2006

Cancer

233

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BACKGROUNDThe purpose of this prospective Phase II study was to analyze morbidity and mortality of cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP) in the treatment of peritoneal surface malignancies.METHODSA total of 205 patients (50 with peritoneal mesothelioma, 49 with pseudomyxoma peritonei, 41 with ovarian cancer, 32 with abdominal sarcomatosis, 13 with colon cancer, 12 with gastric cancer, and 8 with carcinomatosis from other origins) underwent 209 consecutive procedures. Four patients underwent the intervention twice because of disease relapse. There were 70 men and 135 women. Mean age was 52 years (range, 22–76 yrs). CRS was performed by using peritonectomy procedures. IPHP through the closed abdomen technique was conducted with a preheated (42.5 °C) perfusate containing cisplatin + mitomycin C or cisplatin + doxorubicin.RESULTSMajor morbidity rate was 12%. The most significant complications were 23 anastomotic leaks or bowel perforations, 4 abdominal bleeds, and 4 sepses. Operative mortality rate was 0.9%. On logistic regression model multivariate analysis, extent of cytoreduction (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.29–6.40) and dose of cisplatin for IPHP ≥ 240 mg (OR, 3.13; 95% CI, 1.24–7.90) were independent risk factors for major morbidity. Ten patients presented with Grade 3 to 4 toxicity.CONCLUSIONSCRS + IPHP presented acceptable morbidity, toxicity, and mortality rates, all of which support prospective Phase III clinical trials. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionsupporting

confidence: 87%

“…The influence of chemotherapy on the suture‐line healing depends on the type of drug. In animal studies, anastomotic healing can be impaired by intraperitoneal MMC17 and cisplatin18 but not by 5‐fluorouracil19 or paclitaxel 20. Local hyperthermia in itself has no adverse effect on anastomotic healing in animal models 21.…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion

Kusamura

Younan

Baratti³

et al. 2006

Cancer

233

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“…As many series (19), important part of our morbidity is represented by leakages. It has been proved that the use of heated chemotherapy has a detrimental effect on the strength of colonic anastomosis, especially during the early postoperative period (until day 10) (20,21). This may cause anastomotic failure and postoperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Carcinomatosis: Higher Complication Rate for Oxaliplatin Compared to Mitomycin C

Rouers

Laurent

Detroz

et al. 2006

Acta Chirurgica Belgica

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Abstract.Background : Peritoneal carcinomatosis (PC) from colo-rectal cancer carries a very poor prognosis with a mean and median overall survival times of 6.9 and 5.2 months. It has been proved that a locoregional therapeutic approach of this disease with cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) improved survival of these patients. However, this combined treatment presents a high complication rate. Methods : 21 patients with PC of colorectal origin underwent complete cytoreduction followed by HIPEC using Mitomycin-C (13 patients) or oxaliplatin (8 patients) and the open coliseum technique. For each case the medical datas were retrospectively analysed to determine feasibility, morbidity, mortality, survival time and prognostic factors. Results : All patients presented a Sugarbaker's Peritoneal Cancer index inferior to 15. The mean operating time was 453 minutes. After a median follow-up of 24.9 months, actuarial disease-free survival was 36.6% at 5 years. The median survival time was 34 months. The morbidity rate was 33.3% with a significant higher complication rate in the oxaliplatin group (5/8) than in the Mytomycin-C (MMC) group (2/13). One patient (4.7%) died two months after treatment with MMC (endocarditis). Conclusions : This series confirm positive impact of cytoreduction and HIPEC on PC. We obtained a moderated complications rate thanks to a high degree of selection of the patient. Oxaliplatin scheme is responsible of a higher morbidity than in MMC group. Phase III trial comparing these two drugs is needed.

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“…Both experimental and clinical studies show that HIPEC has negative effects on anastomotic healing. Surgeons may prefer either ileostomy or colostomy to prevent abdominal sepsis because of anastomosis leakage (AL), which results in the reduction of patients' quality of life, increased mortality, and morbidity …”

Section: Introductionmentioning

confidence: 99%

The effects of platelet‐rich‐plasma gel application to the colonic anastomosis in hyperthermic intraperitoneal chemotherapy: An experimental rat model

Ocak

Bük

Genç

et al. 2019

International Wound Journal

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Hyperthermic intraperitoneal chemotherapy (HIPEC) has cytotoxic effects on tumour cells but also negative impacts on anastomotic healing. Platelet‐rich‐plasma (PRP) is used for wound care but data about effects on gastrointestinal anastomosis are limited. In this experimental study, we aimed to investigate the effects of PRP application on colon anastomosis in rats those received HIPEC with cisplatin. Five rats were sacrificed to obtain PRP gel. Thirty rats were divided into three groups; Group 1: control group, Group 2: colon anastomosis and HIPEC with cisplatin, and Group 3: colon anastomosis enhanced by PRP and HIPEC with cisplatin. The rats were re‐operated on postoperative day seven and anastomotic bursting pressure (ABP) was recorded. Also, tissue samples were taken for hydroxyproline assessment and histopathological examination. There were significant differences in ABP between Groups 2 and 3, and also those groups had lower ABP compared with the control group. Group 3 had significantly higher hydroxyproline levels and had better histopathological findings than group 2. According to our findings, we suggest that PRP application improves the anastomotic healing by increasing anastomotic bursting pressure, hydroxyproline levels, and decreasing inflammatory response. Further clinical studies are needed to prove our hypothesis.

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Intraperitoneal heated chemotherapy affects healing of experimental colonic anastomosis: An animal study

Cited by 40 publications

References 24 publications

Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion

Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Carcinomatosis: Higher Complication Rate for Oxaliplatin Compared to Mitomycin C

The effects of platelet‐rich‐plasma gel application to the colonic anastomosis in hyperthermic intraperitoneal chemotherapy: An experimental rat model

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