[Post-operative fibrosis: pathophysiological aspects and therapeutical perspectives].
Postoperative fibrosis (POF) is a rare, localized, and irreversible delayed effect of surgery, described in numerous tissues and organs. Is this fibrotic process amenable to therapeutic intervention? A synthesis of various clinical and histopathological aspects, and of cellular and molecular process regulation is described. In summary, there exists a prefibrotic chronic inflammatory phase, a constituted and cellular phase, and lastly a matricial densification and remodelling phase. The respective phases and the roles played over time by the main protagonists, namely myofibroblasts, extracellular matrix and growth factor (TGFbeta1) are clarified. Understanding the mechanism of POF leads logically to treatments derived from our knowledge of the treatment of radiation-induced fibrosis: anti-inflammatory drugs help in the prefibrotic phase, pentoxifylline-tocopherol combination (PE) in the organized fibrotic phase, and pentoclo (PE-clodronate) in the late fibronecrotic phase. Randomized trials are necessary to validate the preliminary results of phase II trials.
Delanian
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Service oncologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010, Paris, France. sylvie. delanian@sls.aphp.fr
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016207:Cytokines / Q000096:biosynthesis; D005347:Fibroblasts / Q000378:metabolism; D005355:Fibrosis; D006225:Hand / Q000473:pathology*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007249:Inflammation / Q000378:metabolism; D011183:Postoperative Complications / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors; D014665:Vasodilator Agents / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D016207:Cytokines; D014665:Vasodilator Agents; D014815:Vitamins