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.
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.
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).
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.
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Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482
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 351:1731–1740
Camma C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M (2000) Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. Jama 284:1008–1015
Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987
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 18:495–499
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 48:1868–1874
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 51:1195–1201
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 29:155–157
Duignan JP, Collins PB, Johnson AH, Bouchier-Hayes D (1986) The association of impaired neutrophil chemotaxis with postoperative surgical sepsis. Br J Surg 73:238–240
Johnson LB, Adawi D, Sandberg S et al (2009) Peripheral leucocyte count variations in rectal cancer treatment. Eur J Surg Oncol 35:611–616
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 48:1573–1580
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 14:1744–1751
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 345:638–646
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 92:211–216
Jestin P, Pahlman L, Gunnarsson U (2008) Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis 10:715–721
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 21:1–6
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 58:204–210
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 85:355–358
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 22:919–927
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 51:902–908
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 CD005341
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 CD007107
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 42:2433–2453
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 25:3158–3167
Makela JT, Kiviniemi H, Laitinen S (2003) Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 46:653–660
Thanks to Miss S Addison for advice.
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Bhangu, A., Nightingale, P., Daniels, D. et al. Neoadjuvant chemoradiotherapy, sepsis and neutrophil levels following radical excision of rectal cancer. Int J Colorectal Dis 25, 723–729 (2010). https://doi.org/10.1007/s00384-010-0886-9
- Rectal cancer
- Neoadjuvant chemoradiotherapy