The effect of neo-adjuvant chemotherapy with 5-fluorouracil on the integrity of colonic anastomoses: a systematic review and meta-analysis of experimental studies on rats

TL;DR

This study finds that pre-surgery chemotherapy with 5-fluorouracil weakens colonic anastomoses in rats, based on a meta-analysis of experimental studies.

Contribution

The paper provides a quantitative meta-analysis of 5-fluorouracil's impact on anastomotic integrity in rat models.

Findings

Control groups had significantly higher hydroxyproline levels than 5FU-treated groups.

5FU-treated groups showed higher adhesion formation and lower bursting pressure, though not statistically significant.

5-fluorouracil negatively affects anastomotic suture integrity in experimental models.

Abstract

Systematic review and update meta-analysis.

This systematic review and meta-analysis was conducted to determine the effect of preoperative (neoadjuvant) chemotherapy with 5-fluorouracil (intraperitoneal) on the integrity of colorectal anastomoses in an experimental rat model.

Emergency surgery in cancer patients undergoing chemotherapy is associated with an increased risk of complications, including anastomotic leakage, and worse survival outcomes. 5FU is widely used in the treatment of GI tumors. The effect of 5FU on anastomotic integrity has been demonstrated previously; this meta-analysis provides a quantitative assessment of this effect.

A literature search was conducted using PubMed and Google Scholar in MEDLINE up to May 2025. Only experimental studies on rat models were selected, which compared a Control group (no chemotherapy) and a group receiving intraperitoneal 5FU. The following outcomes were extracted: anastomotic bursting pressure, severity of adhesion formation, and hydroxyproline levels.

Six studies were included in the meta-analysis. Statistically significant results demonstrated the superiority of the Control group over the 5FU group in terms of hydroxyproline levels (p < 0.00001). The severity of adhesion formation was higher in the group treated with 5FU (p = 0.59). The anastomotic bursting pressure was higher in the Control group (p = 0.36).

5FU had a negative impact on the integrity of the anastomotic suture line, as evidenced by lower hydroxyproline levels. Lower bursting pressure and a higher degree of adhesions were found in the 5FU group; however, these results were not statistically significant.

Figures