1. Is early post-operative treatment with 5-fluorouracil possible without affecting anastomotic strength in the intestine?
- Author
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van der Kolk BM, de Man BM, Wobbes T, and Hendriks T
- Subjects
- Anastomosis, Surgical, Animals, Antimetabolites, Antineoplastic therapeutic use, Colon surgery, Fluorouracil therapeutic use, Ileum surgery, Infusions, Intravenous, Infusions, Parenteral, Male, Postoperative Complications, Rats, Antimetabolites, Antineoplastic adverse effects, Fluorouracil adverse effects, Intestinal Neoplasms drug therapy, Intestinal Neoplasms surgery, Wound Healing drug effects
- Abstract
Early post-operative local or systemic administration of 5-fluorouracil (5-FU) is under investigation as a means to improve outcome after resection of intestinal malignancies. It is therefore quite important to delineate accurately its potentially negative effects on anastomotic repair. Five groups (n = 24) of rats underwent resection and anastomosis of both ileum and colon: a control group and four experimental groups receiving daily 5-FU, starting immediately after operation or after 1, 2 or 3 days. Within each group, the drug (or saline) was delivered either intraperitoneally (n = 12) or intravenously (n = 12). Animals were killed 7 days after operation and healing was assessed by measurement of anastomotic bursting pressure, breaking strength and hydroxyproline content. In all cases, 5-FU treatment from the day of operation or from day 1 significantly (P<0.025) and severely suppressed wound strength; concomitantly, the anastomotic hydroxyproline content was reduced. Depending on the location of the anastomosis and the route of 5-FU administration, even a period of 3 days between operation and first dosage seemed insufficient to prevent weakening of the anastomosis. The effects of intravenous administration, though qualitatively similar, were quantitatively less dramatic than those observed after intraperitoneal delivery. Post-operative treatment with 5-FU, if started within the first 3 days after operation, is detrimental to anastomotic strength and may compromise anastomotic integrity.
- Published
- 1999
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