title: Effects of CO(2) pneumoperitoneum on anastomotic healing in rats receiving preoperative 5-fluorouracil neoadjuvant chemotherapy.
abstract: BACKGROUND
  When used separately, antineoplastic agents and carbon dioxide (CO(2)) pneumoperitoneum have been reported to impair anastomotic healing in experimental animals. However, the effects of their combined use have not been previously investigated. The aim of this study was to investigate the possibility that neoadjuvant chemotherapy with 5-fluorouracil followed by CO(2) pneumoperitoneum would affect the healing of anastomoses in the colon.
  
  
  METHODS
  Sprague-Dawley rats (n = 48) were given 5-fluorouracil (20 mg/kg/day) for 5 days, and were then assigned to one of the three groups. Prior to surgery, the control group received no pneumoperitoneum. The other two groups received pneumoperitoneum at 6 and 12 mmHg, respectively, for 2 hr. The large intestine was transected and anastomosis was performed via median laparotomy. On postoperative days 3 and 7, relaparotomy was performed in half of the rats in each group. From the colon, a segment including the anastomosis was excised. Tissue hydroxyproline levels were measured. For histological evaluation, the Verhofstad scale was modified and used.
  
  
  RESULTS
  No significant differences in hydroxyproline levels were seen across the groups on postoperative days 3 or 7. However, by postoperative day 7, polymorphonuclear leukocytes and necrosis in the 6-mmHg group had decreased markedly, and granulation had improved.
  
  
  CONCLUSIONS
  Overall, these findings suggest that preoperative 5-fluorouracil therapy followed by pneumoperitoneum at 6 or 12 mmHg does not impair anastomotic healing.
authors.affiliation: Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey. ulasmurat@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Ulas
authors.forename: Ilter
authors.initials: I
authors.lastname: Ozer
authors.forename: Metin
authors.initials: M
authors.lastname: Ercan
authors.forename: Yusuf B
authors.initials: YB
authors.lastname: Ozogul
authors.forename: E Birol
authors.initials: EB
authors.lastname: Bostanci
authors.forename: Tulay Temucin
authors.initials: TT
authors.lastname: Keklik
authors.forename: Ummuhani Ozel
authors.initials: UO
authors.lastname: Turkcu
authors.forename: Ayse
authors.initials: A
authors.lastname: Bilgihan
authors.forename: Musa
authors.initials: M
authors.lastname: Akoglu
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000494:pharmacology; D002245:Carbon Dioxide; D003106:Colon / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005472:Fluorouracil / Q000494:pharmacology*; D006909:Hydroxyproline / Q000378:metabolism; D010535:Laparoscopy / Q000379:methods; D008297:Male; D023421:Models, Animal; D009336:Necrosis; D020360:Neoadjuvant Therapy / Q000379:methods*; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D051381:Rats; D017207:Rats, Sprague-Dawley; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000964:Antimetabolites, Antineoplastic; D002245:Carbon Dioxide; D006909:Hydroxyproline; D005472:Fluorouracil