Effects of two conventional preoperative radiation schedules on anastomotic healing in the rat colon.


Bedirli A., Kerem M., Karahacioglu E., Ofluoglu E., Yilmaz T. U. , Pasaoglu H., ...More

European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes, vol.39, no.3, pp.141-7, 2007 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 39 Issue: 3
  • Publication Date: 2007
  • Doi Number: 10.1159/000100111
  • Journal Name: European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.141-7
  • Keywords: preoperative irradiation, anastomosis, healing, colon, matrix metalloproteinases, MATRIX-METALLOPROTEINASE ACTIVITY, TOTAL MESORECTAL EXCISION, RESECTABLE RECTAL-CANCER, INTESTINAL ANASTOMOSES, RANDOMIZED-TRIAL, RADIOTHERAPY, THERAPY, COMPLICATIONS, COLLAGENASE, IRRADIATION
  • Gazi University Affiliated: Yes

Abstract

Background: Preoperative radiotherapy (RT) is an increasingly popular form of adjunct therapy for rectal cancer; however, little is known about its effects on matrix metalloproteinase (MMP) expression in colonic anastomotic healing. Methods: Wistar rats were irradiated to a total dose of 25 or 40 Gy. Four days after the end of RT, an end-to-end colorectal anastomosis was performed. Animals were sacrificed at 1, 3, and 7 days after the anastomosis. A control group was studied similarly, but was not irradiated. Results: No significant differences were found in peritonitis rate and anastomotic complications. The average bursting pressure and breaking strength were only reduced significantly in the rats irradiated with 40 Gy. However, the concentration and the content of hydroxyproline in anastomotic tissues were unchanged. In irradiated rats, MMP-2 and MMP-9 were significantly increased at 40 Gy, but not at 25 Gy. On the other hand, 25-Gy irradiation induced a smaller increase in the level of the tissue inhibitors of metalloproteinase-1 compared with the controls. Conclusion: Anastomotic strength is adversely affected by high-dose fractionated preoperative RT. In contrast, preoperative RT at 25 Gy in five fractions over 5 days is safe with regard to the maintenance of wound strength in colorectal anastomosis. Copyright (c) 2007 S. Karger AG, Basel.