Advertisement

International Journal of Colorectal Disease

, Volume 25, Issue 6, pp 723–729 | Cite as

Neoadjuvant chemoradiotherapy, sepsis and neutrophil levels following radical excision of rectal cancer

  • Aneel BhanguEmail author
  • Peter Nightingale
  • Darren Daniels
  • Raju Tiramula
Original Article
  • 93 Downloads

Abstract

Purpose

This study aimed to determine differences in neutrophil levels between those receiving long-course neoadjuvant chemoradiotherapy (nCXRT) and those proceeding straight to surgery (StS) for rectal cancer, and in those who developed serious septic events within 30 post-operative days within each group.

Method

Patients undergoing elective surgery between 2006 and 2008 were retrospective reviewed. Some 38 received nCXRT, and 46 proceeded StS. Statistical techniques included repeated measures analyses.

Results

There was no significant difference in serious 30-day septic rates (anastomotic leaks, pelvic abscess or generalised sepsis) between treatment groups (nCXRT, 11%; StS, 13%; p = 1.000). Neutrophil levels in the nCXRT group fell significantly and remained lower throughout treatment than those proceeding StS (p < 0.001 within groups, p < 0.001 between groups). The difference in means of the treatment groups was different for those with sepsis than for those without, and the difference in means of those with sepsis and those without is very different for the two treatment groups (p = 0.018).

Conclusion

Chemoradiotherapy reduced neutrophil levels throughout treatment, and post-operative septic patients in this group had even lower levels. Further studies are warranted to fully assess the relationship of neutrophil levels to sepsis, using standardised definitions of sepsis.

Keywords

Sepsis Rectal cancer Neoadjuvant chemoradiotherapy 

Notes

Acknowledgements

Thanks to Miss S Addison for advice.

References

  1. 1.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482CrossRefPubMedGoogle Scholar
  2. 2.
    Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMedGoogle Scholar
  3. 3.
    Camma C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M (2000) Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. Jama 284:1008–1015CrossRefPubMedGoogle Scholar
  4. 4.
    Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987CrossRefGoogle Scholar
  5. 5.
    Valero G, Lujan JA, Hernandez Q, De Las HM, Pellicer E, Serrano A et al (2003) Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications. Int J Colorectal Dis 18:495–499CrossRefPubMedGoogle Scholar
  6. 6.
    Buie WD, MacLean AR, Attard JA, Brasher PM, Chan AK (2005) Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer. Dis Colon Rectum 48:1868–1874CrossRefPubMedGoogle Scholar
  7. 7.
    Martel G, Al-Suhaibani Y, Moloo H, Haggar F, Friedlich M, Mamazza J et al (2008) Neoadjuvant therapy and anastomotic leak after tumor-specific mesorectal excision for rectal cancer. Dis Colon Rectum 51:1195–1201CrossRefPubMedGoogle Scholar
  8. 8.
    Hartley A, Giridharan S, Srihari N, McConkey C, Geh JI (2003) Impaired postoperative neutrophil leucocytosis and acute complications following short course preoperative radiotherapy for operable rectal cancer. Eur J Surg Oncol 29:155–157CrossRefPubMedGoogle Scholar
  9. 9.
    Duignan JP, Collins PB, Johnson AH, Bouchier-Hayes D (1986) The association of impaired neutrophil chemotaxis with postoperative surgical sepsis. Br J Surg 73:238–240CrossRefPubMedGoogle Scholar
  10. 10.
    Johnson LB, Adawi D, Sandberg S et al (2009) Peripheral leucocyte count variations in rectal cancer treatment. Eur J Surg Oncol 35:611–616PubMedGoogle Scholar
  11. 11.
    Johnson LB, Jorgensen LN, Adawi D, Blomqvist P, Asklof GB, Gottrup F et al (2005) The effect of preoperative radiotherapy on systemic collagen deposition and postoperative infective complications in rectal cancer patients. Dis Colon Rectum 48:1573–1580CrossRefPubMedGoogle Scholar
  12. 12.
    Valenti V, Hernandez-Lizoain JL, Baixauli J, Pastor C, Aristu J, Diaz-Gonzalez J et al (2007) Analysis of early postoperative morbidity among patients with rectal cancer treated with and without neoadjuvant chemoradiotherapy. Ann Surg Oncol 14:1744–1751CrossRefPubMedGoogle Scholar
  13. 13.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMedGoogle Scholar
  14. 14.
    Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T et al (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92:211–216CrossRefPubMedGoogle Scholar
  15. 15.
    Jestin P, Pahlman L, Gunnarsson U (2008) Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis 10:715–721CrossRefPubMedGoogle Scholar
  16. 16.
    Korkolis DP, Plataniotis GD, Gondikakis E, Xinopoulos D, Koulaxouzidis GV, Katsilieris J et al (2006) Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer. Int J Colorectal Dis 21:1–6CrossRefPubMedGoogle Scholar
  17. 17.
    Rodriguez-Ramirez SE, Uribe A, Ruiz-Garcia EB, Labastida S, Luna-Perez P (2006) Risk factors for anastomotic leakage after preoperative chemoradiation therapy and low anterior resection with total mesorectal excision for locally advanced rectal cancer. Rev Invest Clin 58:204–210PubMedGoogle Scholar
  18. 18.
    Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358CrossRefPubMedGoogle Scholar
  19. 19.
    Kruschewski M, Rieger H, Pohlen U, Hotz HG, Buhr HJ (2007) Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22:919–927CrossRefPubMedGoogle Scholar
  20. 20.
    Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC et al (2008) Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum 51:902–908CrossRefPubMedGoogle Scholar
  21. 21.
    Massey E, Paulus U, Doree C, Stanworth S (2009) Granulocyte transfusions for preventing infections in patients with neutropenia or neutrophil dysfunction. Cochrane Database Syst Rev CD005341Google Scholar
  22. 22.
    Herbst C, Naumann F, Kruse EB, Monsef I, Bohlius J, Schulz H et al (2009) Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy. Cochrane Database Syst Rev CD007107Google Scholar
  23. 23.
    Aapro MS, Cameron DA, Pettengell R, Bohlius J, Crawford J, Ellis M et al (2006) EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 42:2433–2453CrossRefPubMedGoogle Scholar
  24. 24.
    Kuderer NM, Dale DC, Crawford J, Lyman GH (2007) Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol 25:3158–3167CrossRefPubMedGoogle Scholar
  25. 25.
    Makela JT, Kiviniemi H, Laitinen S (2003) Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 46:653–660CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Aneel Bhangu
    • 1
    Email author
  • Peter Nightingale
    • 2
  • Darren Daniels
    • 3
  • Raju Tiramula
    • 1
  1. 1.Department of Colorectal SurgeryGood Hope HospitalBirminghamUK
  2. 2.The Wellcome Trust Clinical Research FacilityUniversity Hospital Birmingham NHS Foundation TrustBirminghamUK
  3. 3.Department of AnaestheticsGood Hope HospitalBirminghamUK

Personalised recommendations