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

Abstract

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.

Effect of platelet‐rich plasma on colon anastomosis in rats in which hyperthermic intra‐peritoneal chemotherapy was performed using 5‐fluorouracil

“…These results show that the HIPEC procedure decreases tissue hydroxyproline levels in colon anastomosis, but this situation can be improved by the PRP gel application that increases these levels. In our study, significantly lower tissue hydroxyproline levels were detected in the 5‐FU HIPEC groups, which is consistent with the literature 10,24 …”

“…There was also a statistically significant difference between the 5‐FU group and the 5‐FU + PRP group ( P = 0.047), which indicates that PRP significantly increases ABP. These findings suggest that the negative effect of HIPEC on anastomotic healing can be reversed by the application of PRP gel, which is supported by similar studies in the literature 13,23,24,27 …”

Comparison of Platelet-Rich Plasma-Impregnated Suture Material with Low and High Platelet Concentration to Improve Colonic Anastomotic Wound Healing in Rats

“…Association of topical PRP application to anastomosis line with better wound healing has also been reported in other studies of rat colon anastomosis models, based on increased ABP values and higher tissue hydroxyproline levels accompanied with histopathological findings of decreased inflammatory cell infiltration, marked fibroblast development, and rich collagen production identified in the PRP vs. the control group of rats [12,14]. Similarly, Ocak et al reported that PRP administration to intestinal anastomosis in rats that underwent hyperthermic intraperitoneal chemotherapy (HIPEC) decreased inflammatory response, increased anastomotic bursting pressure, and increased hydroxyproline levels [24].…”

Preclinical In Vivo-Models to Investigate HIPEC; Current Methodologies and Challenges

“…Depending on the origin of the used cancer cells, rat and mouse strains were chosen. The following rat types were used in the analyzed articles; Wistar (21%) [ 32 , 45 , 46 , 62 , 63 , 64 ], Sprague Dawley (32%) [ 40 , 43 , 51 , 52 , 57 , 65 , 66 , 67 , 68 ], WAG/Rij (32%) [ 47 , 54 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ] and athymic/nude (14%) [ 44 , 76 , 77 , 78 ] rats. For mouse experiments, the following strains were used: Swiss albino (20%) [ 36 , 38 , 79 ], athymic (33%) [ 37 , 48 , 50 , 55 , 80 ], C57BL/6 (20%) [ 33 , 39 , 81 ], BALB/c (20%) [ 49 , 56 , 82 ] and NOD-SCID (7%) [ 34 ].…”