EFFECT OF FIBRIN SEALANT ON PERIANASTOMOTIC TUMOR-GROWTH IN AN EXPERIMENTAL-MODEL OF COLORECTAL-CANCER SURGERY

Viable intraluminal tumor cells can penetrate a clinically intact rode nt colonic anastomosis and give rise to perianastomotic tumor growth. The aim of this study was to determine whether transanastomotic cell m igration can be prevented by fibrin-based tissue sealant. Following di stal colonic transection and reanastomosis with 5/0 silk sutures, Fisc her F344 rats were randomly allocated to three experimental groups. In Group A, a circumferential ring of tissue sealant was placed around t he serosal surface of the anastomosis; in Group B, sealant was limited to 50 percent of the anastomotic circumference; and, in Group C, no s ealant was applied. All rats then had 10(5) Mtln3 carcinoma cells inje cted into the proximal colonic lumen via a rectal catheter. The incide nce of perianastomotic tumor at 21 days was significantly lower in Gro up A (3 of 14 animals) than in Group B (11 of 16 rats) (P = 0.012; Fis her's exact test) or Group C (10 of 14 rats; P = 0.011). A further exp eriment demonstrated that sealant did not protect the anastomosis when tumor cells were instilled directly into the peritoneal cavity. A top ical carcinocidal action therefore appears unlikely, but our results s uggest that a circumferential anastomotic ring of fibrin sealant forms an effective mechanical barrier preventing intraluminal tumor cells f rom reaching the peritoneal cavity.