Affordable Access

Publisher Website

Effect of chemotherapy, radiation, or immunosuppression on the integrity of the intestinal anastomosis

Elsevier Inc.
DOI: 10.1053/j.scrs.2014.04.008
  • Medicine


Abstract Despite significant advances in surgical technique and perioperative care, anastomotic leak remains an uncommon yet dreaded surgical complication with potential catastrophic consequences for the patient. Other articles in this issue focus on the impact of technical factors including anastomotic technique, bowel preparation, and fecal diversion. This article delves into the effects of chemotherapy, radiation, and immunosuppression on the integrity of the intestinal anastomosis. Although large studies are conflicting regarding the overall impact of perioperative chemotherapy on the risk of anastomotic leak, the antiangiogenesis class of chemotherapy drugs, including bevacizumab, has emerged as a known risk factor. The literature is also somewhat conflicting as to whether neoadjuvant radiation is a risk factor for anastomotic leak in patients with rectal cancer. It is clear, however, that this patient population is at overall high risk for leak, and therefore the recommendation of fecal diversion is well-supported by the literature. The effects of immunosuppression on anastomotic leak have been extensively studied in the IBD and solid-organ transplant populations. Corticosteroids have been shown to increase risk of anastomotic leak in both IBD and non-IBD populations, although a clear dose- or duration-effect has not been determined. For solid-organ transplant patients, the mTOR inhibitors, including sirolimus and everolimus, have been demonstrated to significantly impair wound healing, including anastomoses in animal models, and are thus recommended to be replaced with tacrolimus for 6 weeks preoperatively.

There are no comments yet on this publication. Be the first to share your thoughts.


Seen <100 times

More articles like this

Effect of chemotherapy, radiation, or immunosuppre...

on Seminars in Colon and Rectal S...

Effect of gelfoam on the integrity of intestinal a...

on The American Journal of Surger... October 1951

The effect of Amifostine (Ethyol) on intestinal an...

on European review for medical an... May 2013

[Intestinal anastomosis in radiation sickness].

on Vestnik khirurgii imeni I. I.... October 1956
More articles like this..