The Risks of Perioperative Chemotherapy in Large-Bowel Cancer Surgery

  • U. Metzger
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 98)


The approach of administering perioperative chemotherapy as an adjuvant to curative surgery in large-bowel cancer is really not a modern one, as it might seem to be today. Based on the observation of free malignant cells circulating in the blood during operation (Fisher and Turnbull 1955; Moore et al. 1957), several attemps have been made to treat these cancer cells prophylactically at the time of operation. In the mid-1950s, Warren Cole’s group in Chicago initiated the idea of perioperative chemotherapy (Morales et al. 1957), supposing that cancer cells might be more vulnerable to the action of anticancer agents if given on the day of the operation, before these “loose” cells develop a blood supply. They stated: “Improvement in the 5-year survival rate of the surgical treatment of cancer during the past 10 or 15 years has been made primarily by increasing the extent of the operation. However, there is no hope that further improvement can be expected from this phase of the operation, because we are now approaching anatomical limits in respect to the amount of tissue that can be removed.” This may still be true today. Following experimental research in rats, in March 1956 Cole’s group started the clinical use of nitrogen mustard given to patients at the time of operation. A dose of 0.1 mg/kg body weight was given both through the portal venous system and into the peritoneal cavity during operation, and then IV on postoperative days 1 and 2.


Nitrogen Mustard Portal Venous System Fluorouracil Chemotherapy Umbilical Vein Catheter Veteran Administration Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Blixenkrone N (1959) Mitomen cheotherapy given in relation to operation for cancer of the abdominal organs. Acta Chir Scand 117:189–196Google Scholar
  2. Dwight RW, Higgins GA, Keehn RJ (1969) Factors influencing survival after resection in cancer of the colon and rectum. Am J Surg 117:512–522PubMedCrossRefGoogle Scholar
  3. Dwight RW, Humphrey EW, Higgins GA, Keehn RJ (1973) FUDR as an adjuvant to surgery in cancer of the large bowel. J Surg Oncol 5:243–249PubMedCrossRefGoogle Scholar
  4. Fisher ER, Turnbull RB (1955) The cytological demonstration and significance of tumor cells in the mesenteric venous blood in patients with colorectal cancer. Surg Gynecol Obstet 100:102–108PubMedGoogle Scholar
  5. Grage TB, Metter GE, Cornell GN, Strawitz JG, Hill GJ, Frelick RW, Moss SE (1977) Adjuvant chemotherapy with 5-Fluorouracil after surgical resection of colorectal carcinoma (COG Protocol 7041). A preliminary report. Am J Surg 133:59–66PubMedCrossRefGoogle Scholar
  6. Grossi CE, Wolff WI, Nealon TF, Pasternack B, Ginzburg L, Rousselot LM (1977) Intraluminal fluorouracil chemotherapy adjunct to surgical procedures for resectable carcinoma of the colon and rectum. Surg Gynecol Obstet 145:549–554PubMedGoogle Scholar
  7. Higgins GA, Dwight RW, Swith JV, Keehn RJ (1971) Fluorouracil as an adjuvant to surgery in carcinoma of the colon. Arch Surg 102:339–343PubMedCrossRefGoogle Scholar
  8. Higgins GA, Humphrey E, Juler GL, LeVeen HH, McCaughan J, Keehn RJ (1976) Adjuvant chemotherapy in the surgical treatment of large bowel cancer. Cancer 38:1461–1467PubMedCrossRefGoogle Scholar
  9. Holden WD, Dixon WJ, Kuzma JW (1967) The use of triethylenethiophosphoramide as an adjuvant to the surgical treatment of colorectal carcinoma. Ann Surg 165:481–491PubMedCrossRefGoogle Scholar
  10. Killen JY, Holyoke ED, Moertel CG, Horton J, Schein PS, Ellenberg SS (1981) Adjuvant therapy of adenocarcinoma of the colon following clinically curative resection: an interim report from the GITSG In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer III. Grune and Stratton, New York, pp 527–538Google Scholar
  11. Lawrence W, Terz JJ, Horsley S, Donaldson M, Lovett WL, Brown PW, Ruffner BW, Regelson W (1975) Chemotherapy as an adjuvant to surgery for colorectal cancer. Ann Surg 181:616–623PubMedCrossRefGoogle Scholar
  12. Mittelman A, Moertal CG, Horton J, Levin B, Schein PS, Novak JW (1981) Adjuvant chemotherapy and radiotherapy following rectal surgery: an interim report from the GITSG. In: Jones SE, Salmon SE (eds) Adjuvant therapy of Cancer III. Grune and Stratton, New York, pp 547–557Google Scholar
  13. Moore GE, Sandberg A, Schubarg JR (1957) Clinical and experimental observations of the occurrence and fate of tumor cells in the blood stream. Ann Surg 146:580–587PubMedCrossRefGoogle Scholar
  14. Morales F, Bell M, McDonald G, Cole WH (1957) The prophylactic treatment of cancer at the time of operation. Ann Surg 146:588–595PubMedCrossRefGoogle Scholar
  15. Mrazek R, Economou S, McDonald G, Slaughter P, Cole WH (1959) Prophylactic and adjuvant use of nitrogen mustard in the surgical treatment of cancer. Ann Surg 150:745–755PubMedCrossRefGoogle Scholar
  16. Panettiere FJ (1980) Adjuvant chemotherapy with or without immunotherapy in colorectal cancer. Clin Res 28(5):837AGoogle Scholar
  17. Rousselot LM, Cole DR, Grossi CE, Conte AJ, Gonzales EM (1967) Intraluminal chemotherapy (HN2 or 5-FU) adjuvant to operation for cancer of the colon and rectum. II. Follow-up report of 97 cases. Cancer 20:829–833PubMedCrossRefGoogle Scholar
  18. Taylor I, Rowling JT, West C (1979) Adjuvant cytotoxic liver perfusion for colorectal cancer. Br J Surg 66:833–837PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • U. Metzger
    • 1
  1. 1.Chirurgische Onkologie, Departement ChirurgieUniversitätklinikZürichSwitzerland

Personalised recommendations