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October 1996

Combined Preoperative Irradiation and Local Hyperthermia Delays Early Healing of Experimental Colonic Anastomoses

Author Affiliations

From the Departments of Surgery (Drs Biert, Seifert, Wobbes, and Hendriks and Mr de Man) and Radiotherapy (Dr Hoogenhout), University Hospital Nijmegen, Nijmegen, the Netherlands.

Arch Surg. 1996;131(10):1037-1042. doi:10.1001/archsurg.1996.01430220031006

Objective:  To determine if a combination of preoperative irradiation and local hyperthermia of a colonic segment is detrimental to subsequent early anastomotic healing.

Design:  A prospective randomized experimental trial.

Setting:  An animal research laboratory.

Interventions:  Eighty male Wistar rats were randomly divided into 4 groups. In each animal, a segment of the colon was treated successively by (sham) irradiation and (sham) hyperthermia. After 5 days, a colonic resection was performed and an anastomosis was constructed; the distal limb consisted of (sham) irradiated, (sham) hyperthermia—treated bowel. The rats were killed 3 or 7 days after surgery.

Main Outcome Measures:  Body weight, serum albumin and protein levels, anastomotic bursting pressure, breaking strength, and hydroxyproline content.

Results:  All animals tolerated (sham) treatment well. Weight was diminished, though not notably, in treated animals vs the control group. After combined preoperative irradiation and hyperthermia, the frequency of local anastomotic complications increased: 4 of 20 animals had a covered perforation when they were killed. In this group, the bursting pressure was lower 3 days after the operation (P=.008). The breaking strength was also lower but not notably. The serum albumin level was significantly lower in this group vs the control group (P=.006); the serum protein level was not decreased. After 7 days, no differences existed between the groups. The hydroxyproline content of the anastomotic tissue was notably higher in rats treated with radiation plus hyperthermia vs control rats (in both the 3- and 7-day groups). The anastomotic hydroxyproline concentration did not differ between the groups.

Conclusions:  The combination of preoperative irradiation and hyperthermia results in increased local anastomotic complications. Anastomotic strength is at risk in the first days after the anastomotic reconstruction. Preoperative irradiation or hyperthermia alone does not lead to impaired anastomotic healing in the early phase.Arch Surg. 1996;131:1037-1042.

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