कैंसर विज्ञान एवं चिकित्सा

Could be Reversed the Detrimental Effect of 5-Fluorouracil on Healing of Colonic Anastomosis by Oral Glutamine Supplementation?

Abstract

Burak Kavlakoglu, Recep Pekcici, Faruk Demir, Halil Yaman and Sevim Turanli

Background/Aim: The anti-neoplastic agents are known to impair tissue healing which may lead to significant post-operative complications, like anastomotic leaks. There has been a number of studies that have shown the protective affects of glutamine on the enteric mucosa. Our study aimed to test whether the addition of enteral glutamine to 5-fluorouracil (5FU) used as immediate post-colectomy chemotherapy caused less anastomotic complications compared to 5-FU alone.

Materials and methods: Thirty-six female Wistar-Albino rats were initially divided into three groups of twelve rats. The first and the second twelve formed the control (CG) and the 5-FU groups respectively, and were fed on standard laboratory diet and water for seven days. The third group was the Glutamine group (GG) which had oral glutamine supplements in addition to the standard diet. All animals had a laparotomy on day 7. The left colon was transected and a hand sewn colocolic anastomosis was undertaken (hangi teknik, hand-sewn, single layer, sero-submucosal). All groups were further divided into two subgroups (a total of six groups). The first subgroup in each main group was sacrificed on post-operative day 3, the remainder were killed on day 7. Bursting pressures, tissue-hydroxyproline and histopathology were compared by Anova test.

Results: Bursting pressure values were significantly reduced by 5FU treatment, both at day 3 and day 7 postoperatively. Glutamine treatment prevented the reduction of bursting pressure in 5FU treated animals, which was not significantly different from animals not treated with 5FU. The lowest mean tissue hydroxyproline levels were found in the 5FU-day 3 & day 7 groups, histopathology was superior in 5FU-glutamine-day 7 group.

Conclusion: Glutamine neutralised the detrimental affects of 5-FU on tissue healing. This may enable the early inititiation of adjuvant chemotherapy.