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Postoperative morbidity and mortality in relation to leukocyte counts and time to surgery after short-course preoperative radiotherapy for rectal cancer

Fokstuen, Tone ; Holm, Torbjörn ; Glimelius, Bengt

Radiotherapy and oncology, 2009-11, Vol.93 (2), p.293-297 [Periódico revisado por pares]

Ireland: Elsevier Ireland Ltd

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  • Título:
    Postoperative morbidity and mortality in relation to leukocyte counts and time to surgery after short-course preoperative radiotherapy for rectal cancer
  • Autor: Fokstuen, Tone ; Holm, Torbjörn ; Glimelius, Bengt
  • Assuntos: Adult ; Aged ; Aged, 80 and over ; Female ; Hematology, Oncology and Palliative Medicine ; Humans ; Leukocyte Count ; Leukocytes ; Logistic Models ; Male ; MEDICIN ; Medicin och hälsovetenskap ; MEDICINE ; Middle Aged ; Morbidity ; Mortality ; Postoperative Complications - mortality ; Preoperative radiotherapy ; Radiation-surgery interval ; Rectal cancer ; Rectal Neoplasms - blood ; Rectal Neoplasms - mortality ; Rectal Neoplasms - radiotherapy ; Rectal Neoplasms - surgery ; Retrospective Studies
  • É parte de: Radiotherapy and oncology, 2009-11, Vol.93 (2), p.293-297
  • Notas: ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-1
    ObjectType-News-3
    content type line 23
  • Descrição: Abstract Background Preoperative radiotherapy for rectal cancer decreases local recurrence rates, but increases postoperative complications. Impaired postoperative leukocyte reaction after preoperative short-course radiotherapy has been reported. The aim was to assess postoperative morbidity and mortality in relation to leukocyte reaction and the time interval between radiotherapy and surgery. Materials and methods A retrospective analysis of patients included in the Stockholm I and II trials, randomising patients to surgery alone or to 5 × 5 Gy with immediate surgery, identified pre- and postoperative leukocyte values for 274 patients. Results In the surgery alone group ( n = 144), all but three patients (2%) reacted with leukocytosis (ratio post/preoperative >1.0) on day 1 and all but 9 (6%) on day 5. In the radiotherapy group ( n = 130), 40 (31%) became leukopenic (<4 × 109 cells/L) after radiotherapy, 29 (22%) reacted abnormally (leukopenia or ratio ⩽1.0) on day 1 and 66 (51%) on day 5 (all p < 0.001). Preoperative leukocyte counts did not influence postoperative morbidity, but a poor response on day 1 increased the risk of sepsis ( p < 0.05) and mortality (6/29 (21%) vs. 6/101 (6%), p < 0.05). An interval of 10 days or more between the start of radiotherapy and surgery also had an impact on mortality; 6/17 (35%) vs. 6/113 (5%), p = 0.001. In a logistic regression analysis, the time interval and age were independent predictors of mortality. Conclusions Impaired postoperative leukocyte reaction is frequent after short-course radiotherapy and increases the risk of postoperative complications and death. A longer than recommended radiotherapy–surgery interval also appears to be detrimental for postoperative death, independently of leukocyte response.
  • Editor: Ireland: Elsevier Ireland Ltd
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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