Abdominal and pelvic stop-flow chemotherapy. Effect of chemotherapeutic agents and tissue ischemia on rectoanal pressures.
In hypoxic stop-flow chemoperfusion high doses of chemotherapeutic agents are almost directly administered to locally advanced tumors without risking significant systemic toxicity, although chemotherapy-induced neurotoxicity is still a problem. The aim of the study was to assess rectoanal motility and sensation before, during and after abdominal and pelvic stop-flow chemotherapy using the methods of stationary and ambulatory manometry. Stationary rectoanal manometry was performed within 24 hrs before and repeated 48 hrs after stop-flow chemotherapy in 7 consecutive patients with a history of locally advanced or recurrent abdominal and pelvic tumors. Anal sphincter resting and squeeze pressures, rectal sensitivity, rectoanal inhibitory reflex and rectal volumes at which temporary and permanent urge to defecate were reported were examined. Rectal volume associated with leak of rectal contents and rectal compliance were also assessed. Intraoperatively, changes in rectal and anal resting pressures before, during and after occlusion of the vessels and after administration of chemotherapeutic agent were as well recorded, analyzed and interpreted using ambulatory manometry. Induction of anesthesia reduced distal and proximal anal resting pressures. Vascular occlusion further and dramatically decreased resting pressures at all levels, which were fully recovered after re-establishing local blood circulation and for the rest of the recording period. Intraoperative administration of chemotherapy did not further affect anal resting pressures during or after hypoxia. No significant changes in rectoanal motility and sensation were detected on the 48 hrs postoperative assessment as compared to the preoperative state. Tissue hypoxia induced by vascular occlusion during stop-flow chemotherapy procedure, seems to be the only factor leading to a dramatic drop of anal pressures. Anal pressures fully recover after reperfusion of the isolated area. Furthermore, anorectal motility and sensation are not affected by any direct or indirect toxic action of the chemotherapeutic agents.
Chrysos
E
E
Laboratory of Gastrointestinal Motility, Department of General Surgery, University Hospital of Heraklion, Medical School, University of Crete, Greece. chrysos@med.uoc.gr
Athanasakis
E
E
Vrekousis
T
T
Almarashdah
S
S
Fiorentini
G
G
Xynos
E
E
Zoras
O
O
D000008:Abdominal Neoplasms / Q000098:blood supply / Q000188:drug therapy*; D000368:Aged; D001003:Anal Canal / Q000098:blood supply / Q000187:drug effects*; D000970:Antineoplastic Agents / Q000493:pharmacokinetics*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000098:blood supply / Q000188:drug therapy*; D011312:Pressure; D012007:Rectum / Q000098:blood supply / Q000187:drug effects*
D000970:Antineoplastic Agents