Aarts F, Bleichrodt R P, de Man B, Lomme R, Boerman O C, Hendriks T
Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Ann Surg Oncol. 2008 Nov;15(11):3299-307. doi: 10.1245/s10434-008-0070-4. Epub 2008 Aug 19.
Cytoreductive surgery (CS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) results in limited survival benefit and high morbidity and mortality rates in patients with peritoneal carcinomatosis (PC). Radioimmunotherapy (RIT) after CS of experimental PC has been shown to increase survival and compare favorably to HIPEC. The effects of RIT and HIPEC on wound healing after CS need to be determined.
PC was induced by intraperitoneal inoculation of CC-531 colon carcinoma cells in Wag/Rij rats. Animals were subjected to CS and anastomotic construction only or followed by RIT or HIPEC. RIT consisted of 74 MBq (177)lutetium-labeled anti-CC531 antibody MG1. HIPEC was performed by a closed abdominal perfusion technique using mitomycin-C during 60 minutes. Anastomotic and abdominal wall strength measurements were performed 3 and 5 days after surgery.
At day 5, bursting pressure in ileum and colon anastomoses in the CS + HIPEC group, but not in the CS + RIT group, was lower (P < .01) than in the CS group. In the CS group, the colonic bursting site was more often outside the true anastomotic area (8 of 12 animals) than in the CS + HIPEC (1 of 12) and CS + RIT (5 of 12) groups. Abdominal wall strength in the CS + HIPEC group was significantly (P < .01) lower, at both measuring points, than that in both the CS group and the CS + RIT group. There was no difference between the latter.
As adjuvant to CS, HIPEC showed a decrease in anastomotic and abdominal wall wound strength in a model of PC of CRC, whereas RIT did not.
细胞减灭术（CS）联合热灌注化疗（HIPEC）对腹膜癌（PC）患者的生存获益有限，且发病率和死亡率较高。实验性PC患者在CS后进行放射免疫治疗（RIT）已显示可提高生存率，且与HIPEC相比具有优势。需要确定RIT和HIPEC对CS后伤口愈合的影响。
通过向Wag/Rij大鼠腹腔内接种CC-531结肠癌细胞诱导PC。动物仅接受CS和吻合口构建，或随后接受RIT或HIPEC。RIT包括74 MBq的（177）镥标记抗CC531抗体MG1。HIPEC采用闭腹灌注技术，在60分钟内使用丝裂霉素-C进行。在术后3天和5天进行吻合口和腹壁强度测量。
在第5天，CS + HIPEC组回肠和结肠吻合口的破裂压力低于CS组（P <.01），而CS + RIT组则不然。在CS组中，结肠破裂部位更多位于真正吻合口区域之外（12只动物中有8只），而CS + HIPEC组（12只动物中有1只）和CS + RIT组（12只动物中有5只）则较少。在两个测量点，CS + HIPEC组的腹壁强度均显著低于CS组和CS + RIT组（P <.01）。后两者之间没有差异。
作为CS的辅助治疗，在结直肠癌PC模型中，HIPEC显示吻合口和腹壁伤口强度降低，而RIT则没有。
