Impaired postoperative neutrophil leucocytosis and acute complications following short course preoperative radiotherapy for operable rectal cancer

Hartley, A.; Giridharan, S.; Srihari, Narayanan; McConkey, Chris; Geh, J I

doi:10.1053/ejso.2002.1364

Cited by 20 publications

(20 citation statements)

References 7 publications

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“…In patients without leakage in the present study, CRP levels were substantially increased mainly on postoperative day 1-3, as reported previously [14], but this appears to be the first study demonstrating the potential value of CRP in predicting leakage. In contrast, the WBC count was not elevated in patients with leakage, although it was decreased on postoperative day 1-5 in patients who had received radiotherapy, compared to those who had not, as previously reported [20,21]. The clinical implication of this finding is unclear.…”

Section: Discussionmentioning

confidence: 55%

Increase of serum C‐reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection

Matthiessen¹,

Henriksson

Hallböök

et al. 2007

Colorectal Disease

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The level of the anastomosis was at a median 5 cm (3-12 cm) above the anal verge. There was no 30-day mortality. Nine (27.2%) of the 33 patients developed a symptomatic anastomotic leakage which was diagnosed at a median of 8 days (range 4-14) postoperatively. The serum CRP was increased in patients who leaked from postoperative day 2 onwards (P = 0.004 on day 2; P < 0.001 on day 3-8). The WBC was decreased in preoperatively irradiated patients on days 1-5 (P

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Section: Discussionmentioning

confidence: 55%

Increase of serum C‐reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection

Matthiessen¹,

Henriksson

Hallböök

et al. 2007

Colorectal Disease

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“…Thus, based upon this subgroup analysis, supported by subgroup analyses of the Stockholm I + II studies (52) and the TME study (48, 53), surgery after 5Gyx5 should be performed within 11 days from the start of RT, or delayed for several weeks in order to minimize surgical morbidity and mortality. Even if similar experience has been reported by others (54, 55), the conclusion is based upon retrospective studies, and should be interpreted cautiously. In an analysis of the Stockholm III trial after 657 randomized patients (585 analyzed) (56) and in a validation set to the Dutch study (48), the increased toxicity after a slight delay was no longer seen.…”

Section: Time Interval After Short-course Radiotherapy To Surgerysupporting

confidence: 50%

Optimal Time Intervals between Pre-Operative Radiotherapy or Chemoradiotherapy and Surgery in Rectal Cancer?

Glimelius

2014

Front. Oncol.

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Background: In rectal cancer therapy, radiotherapy or chemoradiotherapy (RT/CRT) is extensively used pre-operatively to (i) decrease local recurrence risks, (ii) allow radical surgery in non-resectable tumors, and (iii) increase the chances of sphincter-saving surgery or (iv) organ-preservation. There is a growing interest among clinicians and scientists to prolong the interval from the RT/CRT to surgery to achieve maximal tumor regression and to diminish complications during surgery.Methods: The pros and cons of delaying surgery depending upon the aim of the pre-operative RT/CRT are critically evaluated.Results: Depending upon the clinical situation, the need for a time interval prior to surgery to allow tumor regression varies. In the first and most common situation (i), no regression is needed and any delay beyond what is needed for the acute radiation reaction in surrounding tissues to wash out can potentially only be deleterious. After short-course RT (5Gyx5) with immediate surgery, the ideal time between the last radiation fraction is 2–5 days, since a slightly longer interval appears to increase surgical complications. A delay beyond 4 weeks appears safe; it results in tumor regression including pathologic complete responses, but is not yet fully evaluated concerning oncologic outcome. Surgical complications do not appear to be influenced by the CRT-surgery interval within reasonable limits (about 4–12 weeks), but this has not been sufficiently explored. Maximum tumor regression may not be seen in rectal adenocarcinomas until after several months; thus, a longer than usual delay may be of benefit in well responding tumors if limited or no surgery is planned, as in (iii) or (iv), otherwise not.Conclusion: A longer time interval after CRT is undoubtedly of benefit in some clinical situations but may be counterproductive in most situations. After short-course RT, long-term results from the clinical trials are not yet available to routinely recommend an interval longer than 2–5 days, unless the tumor is non-resectable at diagnosis.

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“…Mortality was also found to be increased if surgery was performed later in the week after completion of radiotherapy compared with early surgery. Hartley et al 27 recently analyzed retrospective data of a similar patient group and found a correlation between preoperative radiotherapy and impairment of postoperative neutrophil leukocytosis. No association between acute complications and the preoperative and postoperative neutrophil count could be shown.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 40 percent of the adult (older than 30 years) bone marrow lies within the pelvis and the head and neck of the femoral bone; for this reason a fall in circulating hematologic lines is expected when organs in the pelvis are irradiated. 27,30 Plowman 30 could, with different radiotherapy regimes (using 30-55 Gy in 25-30 fractions), show the effect of radiotherapy on peripheral white blood cell count, where lymphocytes halved their circulating numbers after 5 Gy and neutrophils after 7.5 Gy. In our data, the decrease in leukocyte count was most profound after radiation in patients that were to develop infective complications.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Radiotherapy on Systemic Collagen Deposition and Postoperative Infective Complications in Rectal Cancer Patients

Johnson

Jørgensen

Adawi

et al. 2005

Diseases of the Colon &Amp; Rectum

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Impaired postoperative neutrophil leucocytosis and acute complications following short course preoperative radiotherapy for operable rectal cancer

Cited by 20 publications

References 7 publications

Increase of serum C‐reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection

Increase of serum C‐reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection

Optimal Time Intervals between Pre-Operative Radiotherapy or Chemoradiotherapy and Surgery in Rectal Cancer?

The Effect of Preoperative Radiotherapy on Systemic Collagen Deposition and Postoperative Infective Complications in Rectal Cancer Patients

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