RESUMEN
BACKGROUND AND OBJECTIVES: The use of continuous infusion 5-Fluorouracil (5-FU) immediately after surgery may improve the adjuvant treatment of resected colon cancer and is the subject of a national phase III trial (Intergroup no. 0136). The aim was to determine the effect of continuous infusion 5-FU on the bursting pressure of a colon anastomosis. METHODS: Twenty Lewis rats weighing approximately 300 g were subject to sigmoid colectomy and single-layer anastomosis. Ten rats received 5-FU continuously at 600 mg/m2 per day for 7 days; 10 rats served as controls. Ten days postoperatively, the rats were sacrificed and bursting pressure of the colon containing the anastomosis was determined. RESULTS: No anastomotic leaks or intra-abdominal abscesses were identified. Burst pressure of the colon in controls (124+/-13 mm Hg; mean+/-SEM) was not significantly different from those animals receiving 5-FU (115+/-9, P > 0.05). The control rats gained weight (13+/-7 g), which is significantly different from the rats receiving 5-FU (-19+/-13, P=0.04). CONCLUSIONS: Continuous infusion 5-FU postoperatively results in weight loss, but does not affect anastomotic bursting strength in rats. This evidence supports the safety of continuous infusion 5-FU postoperatively in humans.
Asunto(s)
Antimetabolitos Antineoplásicos/administración & dosificación , Colon/cirugía , Fluorouracilo/administración & dosificación , Anastomosis Quirúrgica , Animales , Antimetabolitos Antineoplásicos/farmacología , Fenómenos Biomecánicos , Colon/patología , Fluorouracilo/farmacología , Periodo Posoperatorio , Ratas , Ratas Endogámicas LewRESUMEN
Advanced intra-abdominal cancers are frequently associated with malignant ascites. The aim of this study was to document the frequency and clinical course of patients found to have large-volume ( > or = 3 L) malignant ascites when undergoing a major abdominal operation. Between October 1, 1987 and September 1, 1992, 385 patients with malignant ascites were admitted to hospitals associated with a university medical center. Seventeen with large volume ascites underwent exploration for palliation of bowel obstruction or debulking of tumor. Operative mortality was 41% and mortality correlated with the presence of a nonovarian primary and advanced age. We conclude that patients with large volume nonovarian malignant ascites have a high mortality rate following a major abdominal operation. New approaches such as neoadjuvant or intraperitoneal chemotherapy or possibly peritoneovenous shunt placement at the time of the abdominal operation, are needed to improve the dismal results in this subgroup of patients.