Onkologie 24. Jänner 2012
Effects of suprofilm® on the kidney and liver functions in the patients with gastric and colorectal cancer
Objective: The effects on renal and hepatic functions of Suprofilm® which is commonly used in the prevention of abdominal adhesions, were investigated.
Findings: No statistically significant differences were observed between the three monitoring (AST, CRE and BUN) parameters, among the groups and within each group (p > 0.05).
Conclusion: Hepatic and renal dysfunctions did not occur in the patients as adequate hydration was ensured following the use of two layers of Suprofilm®. We think that Suprofilm® can be safely used as an anti-adhesive agent.
Individuals undergoing laparotomy for any reason are reported to develop postoperative adhesions at various frequencies . Weibel reported an adhesion frequency of 67% in a cadaver study .
Intra-abdominal adhesions cause significant health problems such as postoperative pains, ileus and infertility [3–5]. Therefore, various drugs and modalities are attempted in order to prevent development of postoperative adhesions [6–9]. Suprofilm®, one of the materials developed for this purpose, is one of the most effective products used to prevent adhesions .
Suprofilm® is a macromolecule derived from seaweed [11–12]. It is reported that, due to its macromolecules structure, it may lead to acute renal failures as a result of obstructions in renal tubules during the process of excreting from the body .
Material and method
This preliminary report on the study includes 40 patients, who were divided into 2 groups each containing 20 patients. Patients who had renal and / or hepatic dysfunction or an accompanying disease (hypertension, diabetes mellitus, and coronary artery disease) were excluded from the study.
Patients underwent routine preoperative preparations. CRE, BUN and AST values were recorded before the operation. Plans were made to perform further tests for alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), complete urine analysis, and creatinine clearance in case the preliminary test results were negative.
The patients were operated under general anaesthesia. After performing standard surgical procedures, 2 layers of Suprofilm® of 10 × 15 cm size were placed under the incision line, during the closure of the abdominal wall, followed by standard procedures.
CRE, BUN and AST measurements of were performed in by auto-analyzer (Humalyzer 2000) on the blood samples.
Descriptive statistics were provided. Comparisons between the groups were carried out by Mann-Whitney U test while within-group comparisons were carried out by Wilcoxon W test.
The preliminary results obtained for the first 40 patients were presented in this study. Descriptive statistics about patients and control groups were summarised in Table 1. There were 20 patients in the study group (with Suprofilm® applied), with an average age of 67.75 ± 10.15 years. Seven  patients were female and 13 were male. Twelve  of the patients in the study group had a diagnosis of colorectal cancer while 8 had a gastric cancer diagnosis.
The average age of the 20 patients in the control group, consisting of 5 female and 15 male patients, was 64.85 ± 11.49. This group also consisted of 12 colorectal cancer diagnosis and 8 gastric cancer diagnosis, similar to the study group. Of the 12 patients with a colorectal cancer, 5 were applied right hemi-colectomy (right paramedian incision), 2 had a transverse colectomy (median incision), and 5 were applied left hemicolectomy (left paramedian incision). Three  of the 8 patients with gastric cancer had a total gastrectomy while 5 received a subtotal gastrectomy (median incision).
Of the 12 patients with colorectal cancer, 4 received a right hemi-colectomy (right paramedian incision), 1 was applied a transverse colectomy (median incision) and 7 had a left hemi-colectomy (left paramedian incision). Two  of the 8 patients with gastric cancer underwent to a total gastrectomy while the remaining 6 received a subtotal gastrectomy (median incision).
P values obtained through the results of standard deviation, arithmetic average and between-group evaluations of the obtained CRE, BUN and AST values are given in Table 2. According to these data, the values obtained on the same day for the groups for each of the three parameters (CRE, BUN and AST) show similarities. Based on this finding, it can be said that the groups have similar characteristics.
The observed increase in recurrent laparotomies has led us to understand the importance of postoperative adhesion. The adhesions occurring due to the distorted anatomical structure as a result of recurrent laparotomies makes it difficult to enter into abdomen and to control bleeding. This, in turn, results in extended operation periods, increases morbidity and mortality rates [13–15].
Various studies were conducted in order to demonstrate the importance of deformation on peritoneal surface, ischemic areas, intestinal fistulas and foreign bodies in intra-abdominal adhesions [15–17].
Vasoactive substances and cytokines are released after the injury to the peritoneal surface. As a result, a protein-rich fluid is collected in the intra-peritoneal area. Such coagulated-fluid that is collected onto peritoneum causes adhesion.
Adhesions become matured due to the collagens released from the fibroblasts from the middle of the first day of the injury. Fibrinolytic activity stands out from the 7th day of the injury [17–19].
A variety of agents and methods have been used in clinical and experimental studies in order to prevent intra-peritoneal adhesion. The agents used for this purpose are divided into two groups: those with a local effect and those with a systemic effect. An ideal agent should not have a negative affection wound healing and should not increase fibrosis formation. Furthermore, it should be stable during the first period of adhesion formation and then be absorbed. Agent used systematically should remain at sufficient durations and amounts in the blood and in the body fluids [19–21].
It has been argued that Suprofilm®, of which anti-adhesive effect has been proven by many experimental studies, may cause obstruction and acute tubular necrosis by depositing in kidney tubules during discharge from the body as it is has a macromolecular structure . A previous experimental study we carried out yielded data contradictive to this claim .
Suprofilm ®, when placed between bowel loops at incised or peeled surfaces of the peritoneum, breaks the contact (barrier function) and prevents adhesion. Within approximately 5–7 days, it is disintegrated, passes into the blood circulation system by absorption and then excreted with urinary track.
Values of AST, CRE and BUN were used in order to determine tissue damage and organ dysfunction that may occur during the study. There were no statistically significant differences between pre- and post-operation values in the study group (p > 0.05), and furthermore, the results were in conformity with the results obtained in the control group (p > 0.05).
Suprofilm® usage according to the manufacturer’s instructions (maximum use of 3 layers, providing adequate hydration to the patients, and avoiding from its use in patients with chronic organ dysfunction) has no effect on hepatic and renal functions.
We think that prospective experimental works will be useful in determining the maximum quantity of Suprofilm® that can be safely used.
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*Department of General Surgery, Selcuklu Medical Faculty, Selcuk University, Turkey
**Department of Biochemistry, Selcuklu Medical Faculty, Selcuk University, Turkey
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