The influence of an intravenous 5-day combined chemotherapy with bleomycin (2 mg/kg/d), 5-fluorouracil (10 mg/kg/d) and cis-diamminedichloroplatinum (0.35 mg/kg/d) on the healing of ileal anastomoses was investigated in rats. Ninety-six male Wistar rats were used, divided into four groups. The rats in the control group had surgery without administration of cytostatic agents. The other rats were operated either 2 days after, 2 days before, or during the 5-day chemotherapy course. In each group, rats were killed after 3, 7, and 21 days. Anastomotic healing was assessed by measurement of bursting pressures and hydroxyproline levels. Intestinal healing appeared to be impaired most if the operation was performed in the middle of the antineoplastic chemotherapy course. The effects were most pronounced on the seventh postoperative day. Surgery on the second day after the chemotherapy course led to a slight and early delay in wound healing as measured by the hydroxyproline content. Seven days postoperatively, concentrations had returned to preoperative values. Surgery 2 days before chemotherapy induced only minor differences with respect to the control group. In all groups, bursting pressure and hydroxyproline content at 21 days were similar. Thus, antineoplastic agents retard but do not prevent healing of intestinal anastomoses. The effects are most pronounced when surgery is performed during chemotherapy. If possible, surgery should be performed prior to chemotherapy. Increasing the time interval between surgery and chemotherapy may decrease the delay in intestinal woundhealing.Cancer 58:62-66, 1986.
HE USE OF ANTINEOPLASTIC AGENTS as adjuvantT chemotherapy following surgical treatment of malignant diseases has become increasingly important. Administration of these cytotoxic drugs in the perioperative period may improve the resectability of tumors or reduce the incidence of distant or local metastases by, for instance, killing spilled tumor cells at the time of operation. One important question, however, is whether or not they exert an adverse effect on the healing of surgical wounds. Several reports describe the effect of various antineoplastic agents on the healing of intestinal ana~tomoses.'-~ In these experiments, chemotherapy consists of either a single or sequential postoperative injections of one cytostatic agent, or single injections of a combination of drugs. In clinical practice, however, most regimens consist of From the Department of General Surgery, St. Radboud University Hospital, Nijmegen, The Netherlands.Address for reprints: DBW de Roy van Zuidewijn, MD, Department of General Surgery, St. Radboud University Hospital, P. 0. Box 9 10 I , 6500 HB Nijmegen, The Netherlands.The authors thank the staff of the Central Animal Laboratory of the Medical Faculty (head: Dr. WJI van der Gulden), for administering the intravenous injections; and Dr. Ph. van Elteren (Department of Statistical Support, IJniversity of Nijmegen), for performing the statistical analysis of the experimental data.Accepted for publication ...