Peripheral leucocyte count variations in rectal cancer treatment

Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III Trial

“…The present study has shown an association between a poor postoperative leucocyte response and more postoperative complications, which supports the findings of earlier studies. The SRT group with immediate surgery had more patients with a poor leucocyte response, which might be one explanation for its increased risk of postoperative complications.…”

“…RT also increases postoperative morbidity, however, and, in some studies, mortality. Reasons suggested for this have been an increase in systemic cytokines or depressed bone marrow resulting in preoperative leucopenia and/or impaired postoperative leucocytosis. The positive association between impaired leucocyte responses, defined as a low ratio between postoperative and preoperative leucocyte counts (LC ratio), and postoperative complications has been demonstrated previously.…”

Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer

“…If the RT schedules are compared within the Stockholm III Trial, Papers I and III showed the highest risk of complications in the SRT arm. Paper III also showed an association between a poor postoperative LC response and a higher risk of a complication, which supports findings in earlier studies 81,82,102 . The SRT arm had the highest proportion of patients with a poor LC response after surgery, which might be one explanation of the difference in complication rates.…”

“…In Malmö Johnson et al reported from a retrospective study suppression of leucocytes and an impaired postoperative response in patients having preoperative RT, both short and long-course, compared to non-irradiated patients. The patients with an impaired leucocyte response also had more postoperative complications 81 .…”

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

“…145,146 Other studies found a correlation between overall post-operative complications and low leukocyte ratio in the 2 first days after surgery, in irradiated patients. 147 However, a large Dutch registry based study analysed 2131 patients and concluded that there was a higher probability of anastomotic leaks (AL) in patients having surgery 0-3 days compared to 4-14 days after end of RT (10.1% vs 7.2 %, p=0.018). 148 In conclusion, the exact timing of surgery seems to matter in the early period, depending on the outcomes of interest.…”