Morphological characteristics of anastomosis formation zone in patients with colorectal cancer after neoadjuvant radiation therapy

Authors

Keywords:

colorectal cancer, radiation therapy, anastomosis, intraoperative fluorescence angiography, morphology.

Abstract

Background. Intraoperative fluorescence angiography with indocyanine green may be used in colorectal surgery as an objective assessment of intestinal wall perfusion during colorectal anastomosis. For these circumstances, in particular respect for the meritorious designation of the morphological substrate for microcirculation in the proximal and distal zones of resection and specific compensatory-regenerative mechanisms, it would be healthy to ensure the anastomosis during surgical intervention. Objective. Determination of morphological changes and the state of the microcirculatory bed of the rectal wall in the area of its resection and the formation of an anastomosis in patients with colorectal cancer after undergoing neoadjuvant radiation therapy. Methods. In quantitative morphological study, intraoperative samples of the rectum of patients with colorectal cancer, who underwent radiation therapy before the formation of a colorectal anastomosis, were studied. Results and conclusion. The leading systemic microcirculation changes in the intestinal wall that occur in patients with rectal cancer are: 1) hypertrophy of myocytes of the walls of arteries and arterioles of the mucous and tunica muscularis in response to moderate circulatory hypoxia; 2) expansion of the somatic capillaries of tunica muscularis by 63.9% with limitation of transendothelial gas exchange; 3) moderate interstitial edema with hypotrophy of the epithelium of the intestinal crypts and moderate atrophic-dystrophic changes in the myocytes of the muscle sheath. The specified changes limit the level of perfusion of the rectum, but allow the formation of a safe anastomosis under the conditions of maintaining sufficient compensatory and regenerative potential of the microcirculatory bed. Local irreversible microcirculatory injuries, the boundaries of which are determined using intraoperative fluorescence angiography and are observed in the area of ​​neoadjuvant radiation therapy, include: 1) dystrophic changes in myocytes, sclerosing and swelling of the walls of arteries and arterioles of the mucous with the formation of perivascular infiltrates and active inflammation; 2) devastation of visceral capillaries and venules, progression of dystrophic and necrobiotic changes in the epithelium and myocytes of the mucous with the development of edema and hemorrhages; 3) destruction of the vessels of the intermuscular plexus and somatic hemocapillaries of tunica muscularis with the formation of significant hemorrhages and necrotic zones; 4) sharp perivascular and interstitial edema, polymorphic cell infiltration, deformation of the general histoarchitectonics of the mucous and tunica muscularis. These injuries make it impossible to restore adequate blood supply after surgery and lead to failure of the colorectal anastomosis formed in the zone of decompensated microcirculation.

References

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Published

2022-10-10

How to Cite

Savenkov, . D. (2022). Morphological characteristics of anastomosis formation zone in patients with colorectal cancer after neoadjuvant radiation therapy. Морфологія / Morphologia / Morfologìâ, 16(3), 103–109. Retrieved from https://morphology.dma.edu.ua/article/view/281931

Issue

Vol. 16 No. 3 (2022)

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