Comparison of the effects of various anticancer agents on intestinal anastomosis after intraperitoneal administration

Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancer

INTRODUCTION

The use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity.

METHODS

We retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded. The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups.

RESULTS

A total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old. The overall major surgical morbidity (Clavien-Dindo 3-5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p=0.643). There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p=0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p=0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed.

CONCLUSIONS

Perioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.

Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancer

INTRODUCTION

The use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity.

METHODS

We retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded. The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups.

RESULTS

A total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old. The overall major surgical morbidity (Clavien-Dindo 3-5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p=0.643). There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p=0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p=0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed.

CONCLUSIONS

Perioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.

Harnessing cancer immunotherapy during the unexploited immediate perioperative period

The immediate perioperative period (days before and after surgery) is hypothesized to be crucial in determining long-term cancer outcomes: during this short period, numerous factors, including excess stress and inflammatory responses, tumour-cell shedding and pro-angiogenic and/or growth factors, might facilitate the progression of pre-existing micrometastases and the initiation of new metastases, while simultaneously jeopardizing immune control over residual malignant cells. Thus, application of anticancer immunotherapy during this critical time frame could potentially improve patient outcomes. Nevertheless, this strategy has rarely been implemented to date. In this Perspective, we discuss apparent contraindications for the perioperative use of cancer immunotherapy, suggest safe immunotherapeutic and other anti-metastatic approaches during this important time frame and specify desired characteristics of such interventions. These characteristics include a rapid onset of immune activation, avoidance of tumour-promoting effects, no or minimal increase in surgical risk, resilience to stress-related factors and minimal induction of stress responses. Pharmacological control of excess perioperative stress-inflammatory responses has been shown to be clinically feasible and could potentially be combined with immune stimulation to overcome the direct pro-metastatic effects of surgery, prevent immune suppression and enhance immunostimulatory responses. Accordingly, we believe that certain types of immunotherapy, together with interventions to abrogate stress-inflammatory responses, should be evaluated in conjunction with surgery and, for maximal effectiveness, could be initiated before administration of adjuvant therapies. Such strategies might improve the overall success of cancer treatment.

Effects of oxaliplatin and 5-fluorouracil on the healing of colon anastomoses

PURPOSE

Oxaliplatin (OX) and 5-fluorouracil (5-FU) are the most widely used chemotherapeutic agents in the adjuvant treatment of colon cancer. Although the early initiation of adjuvant chemotherapy can improve the outcome of surgery, it carries potentially fatal risks. This experimental study investigates the effects of 5-FU and OX on colon anastomoses.

METHODS

We used 60 rats, divided into six groups. After being subjected to bowel resection and anastomosis, the rats were given 5-FU on days 1-3, or OX 130 mg/m(2) on days 1 or 5, or 5% dextrose as a control. The bursting pressures and hydroxyproline content of the anastomoses were measured, and complications and adhesions were recorded.

RESULTS

There were no major complications in the treatment groups. The bursting pressures of the 5-FU group were significantly lower than those of the control and OX groups. The bursting pressures of the OX groups were not significantly different from those of the control groups. The hydroxyproline levels of the rats treated with OX on day 1 were significantly lower than those of the rats treated with OX on day 5 and the 5-FU groups.

CONCLUSION

Oxaliplatin and 5-FU did not compromise wound healing of the colon significantly. Our results indicate that OX is less detrimental to the healing of colonic anastomoses, when administered on days 1 and 5 after resection, than 5-FU.