Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, Mannheim, Germany,
Ann Surg Oncol. 2013 Dec;20 Suppl 3:S709-15. doi: 10.1245/s10434-013-3209-x. Epub 2013 Aug 23.
The combination of neoadjuvant radiochemotherapy and parenchyma-preserving sleeve resection for lung cancer remains controversial because of potentially increased rate of anastomotic breakdown. We analyzed the effects of applying a decellularized human dermis transplant seeded with autologous fibroblasts in a rodent sleeve resection model with neoadjuvant radiotherapy.
A total of 64 male Fisher rats underwent a transsection and surgical anastomosis of the left main bronchus and were randomized to receive plus/minus radiation treatment and plus/minus augmentation of the anastomosis with a fibroblast-seeded dermis transplant (2 × 2 factorial design). A μCT scan was performed at postoperative days 7 and 14, and the animals were sacrificed on day 14. Anastomotic bursting pressure and hydroxyproline concentration were measured.
In the irradiated groups, the anastomotic bursting pressure was significantly higher in the augmented group at day 7 (100.9 ± 18.3 vs 141.3 ± 18.0 kPa, p = 0.0005) but not at day 14. Hydroxyproline levels showed a similar pattern in the irradiated group with significant differences at day 7 (7 days postoperative 158 ± 11.6 vs 198.2 ± 10.9 nmol/mg, p < 0.0001) but not at day 14 postoperatively.
Augmentation of a bronchial anastomosis by a dermal matrix, seeded with autologous, viable fibroblasts improves early wound breaking strength. Fibroblast-enhanced dermal matrices provide a new and easily usable tool to prevent early anastomotic leakage after neoadjuvant chemoradiation in locally advanced lung cancer.
新辅助放化疗联合肺保存袖状切除术治疗肺癌仍存在争议，因为吻合口破裂的风险可能会增加。我们分析了在新辅助放疗的啮齿动物袖状切除模型中应用去细胞人真皮移植并接种自体成纤维细胞的效果。
共 64 只雄性 Fisher 大鼠接受左主支气管横断和手术吻合，并随机接受加/不加放射治疗和加/不加成纤维细胞接种真皮移植的吻合口增强（2×2 析因设计）。术后第 7 天和第 14 天进行 μCT 扫描，第 14 天处死动物。测量吻合口爆裂压和羟脯氨酸浓度。
在照射组中，增强组在第 7 天的吻合口爆裂压明显更高（100.9±18.3 对 141.3±18.0kPa，p=0.0005），但在第 14 天无差异。羟脯氨酸水平在照射组中也表现出相似的模式，第 7 天有显著差异（术后 7 天 158±11.6 对 198.2±10.9nmol/mg，p<0.0001），但第 14 天无差异。
用自体活成纤维细胞接种真皮基质增强支气管吻合口可提高早期伤口破裂强度。纤维母细胞增强真皮基质为局部晚期肺癌新辅助放化疗后早期吻合口漏提供了一种新的、易于使用的工具。
