Evaluating the Safety of Two Human Experimental Intestinal Ischemia Reperfusion Models: A Retrospective Observational Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Jun 18

PMID 34143845

Authors

Inca H R Hundscheid

Dirk H S M Schellekens

Joep Grootjans

Marcel den Dulk

Ronald M van Dam

Geerard L Beets

Wim A Buurman

Kaatje Lenaerts

Joep P M Derikx

Cornelis H C Dejong

Affiliations

Soon will be listed here.

Abstract

Background: We developed a jejunal and colonic experimental human ischemia-reperfusion (IR) model to study pathophysiological intestinal IR mechanisms and potential new intestinal ischemia biomarkers. Our objective was to evaluate the safety of these IR models by comparing patients undergoing surgery with and without in vivo intestinal IR.

Methods: A retrospective study was performed comparing complication rates and severity, based on the Clavien-Dindo classification system, in patients undergoing pancreatoduodenectomy with (n = 10) and without (n = 20 matched controls) jejunal IR or colorectal surgery with (n = 10) and without (n = 20 matched controls) colon IR. Secondary outcome parameters were operative time, blood loss, 90-day mortality and length of hospital stay.

Results: Following pancreatic surgery, 63% of the patients experienced one or more postoperative complications. There was no significant difference in incidence or severity of complications between patients undergoing pancreatic surgery with (70%) or without (60%, P = 0.7) jejunal IR. Following colorectal surgery, 60% of the patients experienced one or more postoperative complication. Complication rate and severity were similar in patients with (50%) and without (65%, P = 0.46) colonic IR. Operative time, amount of blood loss, postoperative C-reactive protein, length of hospital stay or mortality were equal in both intervention and control groups for jejunal and colon IR.

Conclusion: This study showed that human experimental intestinal IR models are safe in patients undergoing pancreatic or colorectal surgery.

References

Derikx J, Matthijsen R, de Bruine A, van Bijnen A, Heineman E, M van Dam R . Rapid reversal of human intestinal ischemia-reperfusion induced damage by shedding of injured enterocytes and reepithelialisation. PLoS One. 2008; 3(10):e3428. PMC: 2561292. DOI: 10.1371/journal.pone.0003428. View

Kirchhoff P, Clavien P, Hahnloser D . Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010; 4(1):5. PMC: 2852382. DOI: 10.1186/1754-9493-4-5. View

Feuerstadt P, Brandt L . Colon ischemia: recent insights and advances. Curr Gastroenterol Rep. 2010; 12(5):383-90. DOI: 10.1007/s11894-010-0127-y. View

Ouellette J, Small D, Termuhlen P . Evaluation of Charlson-Age Comorbidity Index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg. 2004; 8(8):1061-7. DOI: 10.1016/j.gassur.2004.09.045. View

Cheng Q, Zhang B, Zhang Y, Jiang X, Zhang B, Yi B . Predictive factors for complications after pancreaticoduodenectomy. J Surg Res. 2007; 139(1):22-9. DOI: 10.1016/j.jss.2006.07.028. View

. American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia. Gastroenterology. 2000; 118(5):951-3. DOI: 10.1016/s0016-5085(00)70182-x. View

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J . Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138(1):8-13. DOI: 10.1016/j.surg.2005.05.001. View

Winter J, Cameron J, Campbell K, Arnold M, Chang D, Coleman J . 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006; 10(9):1199-210. DOI: 10.1016/j.gassur.2006.08.018. View

Homer-Vanniasinkam S, Crinnion J, Gough M . Post-ischaemic organ dysfunction: a review. Eur J Vasc Endovasc Surg. 1997; 14(3):195-203. DOI: 10.1016/s1078-5884(97)80191-8. View

10.

Gooiker G, Lemmens V, Besselink M, Busch O, Bonsing B, Molenaar I . Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg. 2014; 101(8):1000-5. DOI: 10.1002/bjs.9468. View

11.

Brandt L, Feuerstadt P, Longstreth G, Boley S . ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 2015; 110(1):18-44. DOI: 10.1038/ajg.2014.395. View

12.

Stojadinovic A, Brooks A, Hoos A, Jaques D, Conlon K, Brennan M . An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg. 2003; 196(6):954-64. DOI: 10.1016/S1072-7515(03)00010-3. View

13.

Fukatsu K, Sakamoto S, Hara E, Ueno C, Maeshima Y, Matsumoto I . Gut ischemia-reperfusion affects gut mucosal immunity: a possible mechanism for infectious complications after severe surgical insults. Crit Care Med. 2005; 34(1):182-7. DOI: 10.1097/01.ccm.0000196207.86570.16. View

14.

Derikx J, Matthijsen R, de Bruine A, M van Dam R, Buurman W, Dejong C . A new model to study intestinal ischemia-reperfusion damage in man. J Surg Res. 2010; 166(2):222-6. DOI: 10.1016/j.jss.2009.09.046. View

15.

Glowka T, Webler M, Matthaei H, Schafer N, Schmitz V, Kalff J . Delayed gastric emptying following pancreatoduodenectomy with alimentary reconstruction according to Roux-en-Y or Billroth-II. BMC Surg. 2017; 17(1):24. PMC: 5359898. DOI: 10.1186/s12893-017-0226-x. View

16.

Borstlap W, Westerduin E, Aukema T, Bemelman W, Tanis P . Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection: Results From a Large Cross-sectional Study. Ann Surg. 2017; 266(5):870-877. DOI: 10.1097/SLA.0000000000002429. View

17.

Fink M, Delude R . Epithelial barrier dysfunction: a unifying theme to explain the pathogenesis of multiple organ dysfunction at the cellular level. Crit Care Clin. 2005; 21(2):177-96. DOI: 10.1016/j.ccc.2005.01.005. View

18.

Nelson H, Sargent D, Wieand H, Fleshman J, Anvari M, Stryker S . A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004; 350(20):2050-9. DOI: 10.1056/NEJMoa032651. View

19.

Grootjans J, Thuijls G, Derikx J, M van Dam R, Dejong C, Buurman W . Rapid lamina propria retraction and zipper-like constriction of the epithelium preserves the epithelial lining in human small intestine exposed to ischaemia-reperfusion. J Pathol. 2011; 224(3):411-9. DOI: 10.1002/path.2882. View

20.

Hundscheid I, Grootjans J, Lenaerts K, Schellekens D, Derikx J, Boonen B . The Human Colon Is More Resistant to Ischemia-reperfusion-induced Tissue Damage Than the Small Intestine: An Observational Study. Ann Surg. 2015; 262(2):304-11. DOI: 10.1097/SLA.0000000000001131. View