Ann Surg Treat Res.  2020 Feb;98(2):89-95. 10.4174/astr.2020.98.2.89.

Is platelet-rich plasma improves the anastomotic healing in hyperthermic intraperitoneal chemotherapy with oxaliplatin: an experimental rat study

• Buk OF
• Ocak S
• Genc B
• Avcı B
• Uzuner HO

• KMID: 2469108
• DOI: http://doi.org/10.4174/astr.2020.98.2.89

Abstract

PURPOSE
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a novel treatment option for peritoneal surface malignancies. Due to cytotoxic effects of chemotherapeutic agents, anastomosis healing can be impaired and lead to leakage rates higher than conventional intestinal surgery. In this experimental study, we aimed to investigate the effects of platelet-rich plasma (PRP) on colonic anastomosis in rats that received HIPEC with oxaliplatin.
METHODS
Thirty rats were divided into 3 groups. Group 1 was determined as control group and hyperthermic saline perfusion was performed after colon anastomosis. In group 2, colon anastomosis then hyperthermic oxaliplatin perfusion was performed. In the last group, the colonic anastomosis was enhanced by PRP gel and then hyperthermic oxaliplatin perfusion was performed. All the rats were reoperated on postoperative day 7 and anastomotic bursting pressure values were recorded. Tissue samples were taken for hydroxyproline assay and histopathological examination.
RESULTS
Control group had higher anastomotic bursting pressure value than group 2 and group 3 (P < 0.001). There were significant differences in anastomotic bursting pressure between groups 2 and 3 (P < 0.001). Group 2 had significantly lower hydroxyproline levels than group 3 and control group (P < 0.001). Histopathological examination revealed that PRP application reduced inflammatory response.
CONCLUSION
PRP application on colonic anastomosis improves anastomotic healing and can reduce anastomosis related complications and stoma creation; though further clinical studies are needed.

Keyword

Anastomotic leak; Colonic neoplasms; Hyperthermia; Oxaliplatin; Platelet-rich plasma

MeSH Terms

Anastomotic Leak
Animals
Colon
Colonic Neoplasms
Drug Therapy*
Fever
Hydroxyproline
Perfusion
Platelet-Rich Plasma*
Rats*
Hydroxyproline

Figure

• 

  Fig. 1 (A) Three layers were seen after first spin; plasma, buffy coat, and red blood cells layers. (B) Gel form of platelet-rich plasma.

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  Fig. 2 Study protocol. PRP, platelet-rich plasma; HIPEC, hyperthermic intraperitoneal chemotherapy. Group 1, control group; group 2, oxaliplatin alone group; group 3, oxaliplatin and platelet-rich plasma group.

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  Fig. 3 The gel form of platelet-rich plasma was applied around the colonic anastomosis. It adheres quickly to the anastomotic site and was not affected by hyperthermic oxaliplatin perfusion.

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  Fig. 4 (A) Group 1: There is marked submucosal bringing, less edema, and inflammation (H&E, ×40). (B) Group 2: There is huge necrotic exudate on the luminal surface and between the anastomosis sides (H&E, ×40). (C) Group 3: There is less inflammation, edema and more bringing (H&E, ×40). Group 1, control group; group 2, oxaliplatin alone group; group 3, oxaliplatin and platelet-rich plasma group.

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