SYSTEMATIC REVIEW article
Front. Surg.
Sec. Colorectal and Proctological Surgery
This article is part of the Research TopicEvaluating surgical techniques and perioperative strategies in colorectal cancer treatmentView all 15 articles
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
Provisionally accepted
- Far Eastern Federal University, Vladivostok, Russia
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Study Design. Systematic review and update meta-analysis. Purpose. 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. Overview of Literature. 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. Methods. 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. Results. 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). Conclusions. 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.
Keywords: 5-fluorouracil, Intestinal anastomoses, Meta-analysis, Neoadjuvant chemotherapy, Systematic review
Received: 11 Nov 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Chernyshenko, Polkin, Ashyrov, Shepelev and Goncharuk. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Roman Polkin
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