Abstract
Purpose 5-flourourasil (5-FU) is commonly used for early intraperitoneal chemotherapy in colorectal or appendiceal cancer patients with peritoneal carcinomatosis. Due to its effect, anastomosis healing can be impaired and leads to anastomotic leakage. In this study, we aimed to investigate the potential healing effect of platelet-rich plasma (PRP) on colonic anastomosis impaired by intraperitoneal 5-flourouracil application.Methods After ten rats were sacrificed for preparing PRP, forty Wistar-albino rats were subjected to colonic anastomosis, and randomly allocated into four groups including 10 rats each. According to receiving PRP and/or 5-FU application, the groups were formed as control (C), 5-FU without PRP (CT), anastomosis with PRP (C-PRP), and 5-FU with PRP (CT-PRP). CT and CT-PRP groups also received 5-FU intraperitoneally on postoperative day 1 (POD 1). All animals were euthanized on pod 7. The body weight change, anastomotic bursting pressure (ABP), tissue hydroxiprolin (TH) and histopathological examination of each group were analyzed.Results 5-FU application significantly reduced ABP levels when compared with group C, C-PRP and CT-PRP (for each comparison, p<0,01). PRP application in CT-PRP group raised the measure of ABP up to the levels of C group. Although tissue hydroxyproline levels (THL) levels of CT-PRP group were found higher than CT group, it was not significant (p=0.112). Microscopically, comparing with CT group, PRP application significantly promoted the healing of colonic anastomosis subjected to 5-FU application by improving tissue edema, necrosis, submucosal bridging and collagen formation (p<0.05). Tissue healing in CT-PRP group was observed as good as the control groups. (C, C-PRP, p=0.181, p=0.134; respectively).Conclusion PRP administration on colonic anastomosis significantly promotes the healing process of anastomosis in rats receiving 5-FU. This result encourages further clinical use of PRP to reduce the frequency of AL in patients receiving EPIC.
Highlights
Cytoreductive surgery (CRS) with intraperitoneal chemotherapy (IPC) is considered as an aggressive surgical technique; it yields potential oncological results for colorectal or appendiceal cancer patients with peritoneal dissemination[1,2,3]
The mean body weights were reduced in all groups during the study period, there was no statistical difference among the groups in terms of body weight changes on postoperative day 1 (POD) 7
The anastomotic bursting pressure was measured at a mean value of 232.6 ± 19.5, 127.5 ± 17.7, 246.7 ± 25.1 and 202.9 ± 28.8 mm-Hg, in group C, CT, C-platelet-rich plasma (PRP) and CT-PRP; respectively
Summary
Cytoreductive surgery (CRS) with intraperitoneal chemotherapy (IPC) is considered as an aggressive surgical technique; it yields potential oncological results for colorectal or appendiceal cancer patients with peritoneal dissemination[1,2,3]. Because AL is related to multifactorial conditions including patient characteristic, surgical technique, tumor biology, administered medicine etc., it seems the debates and the efforts will continue for a long time to prevent this complication[12,13]. Among these factors leading to AL what surgeons can act directly is to strengthen and facilitate to improve the healing of the anastomotic line
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