The Effects of Cisplatin on Gastrostomy Site Healing

Abstract

Background: Gastrostomy tube placement is sometimes necessary during chemoradiation for head and neck cancer (HNC), but it is associated with worse swallowing outcomes. Despite best efforts, the need for gastrostomy cannot be perfectly predicted, and some patients develop the need for gastrostomy while undergoing chemotherapy. To date, the impact of cisplatin on gastrostomy site healing has not been investigated. The aim of this study is to compare the levels of procollagen, connective tissue growth factor (CTGF), and CD26 in the gastrostomy sites of mice at varying timepoints after cisplatin versus saline. Methods: For this study we used 32 C57BL/6 mice. Cisplatin (1 mg/kg) was injected intraperitoneally into the mice from treatment groups. Control groups received the same volume of normal saline intraperitoneally. Mice underwent gastrostomy tube placement at 7, 10, 14, and 17 days post cisplatin or saline therapy. Ten days after gastrostomy placement, mice were sacrificed, and the gastrostomy site tissue was examined. We measured the levels of procollagen type 1, CTGF, and CD26 by flow cytometry. Massons trichrome stain was used for qualitative comparison of collagen formation in surgical site tissue. Results: Massons trichrome staining showed more collagen formation in surgical site tissue at 17 versus 7 days post-cisplatin. Levels of procollagen type 1 by flow cytometry were significantly higher in the control group compared to the treatment group (P < 0.0001) for each time point. There was a statistically significant difference in procollagen type 1 between the 7 days post-chemotherapy group and the 17 days post-chemotherapy group (P = 0.0024). The percentage of cells with procollagen, CTGF, and CD26 in the 7 days post-saline control group were similar to the percentage in the 14 days post-cisplatin treatment group. Conclusions: CTGF, CD26, and procollagen were decreased by cisplatin in gastrostomy site tissue at each time point, but levels 14 days after a cisplatin treatment approximate the levels 7 days after saline. These results suggest that it is safe to proceed with gastrostomy tube placement 14 - 17 days after cisplatin because the CTGF, CD26, and procollagen levels approximate the levels 7 days after saline. Additional studies are needed to extrapolate to humans. J Curr Surg. 2023;13(1):6-11 doi: https://doi.org/10.14740/jcs468