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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Postoperative morbidity and mortality in relation to leukocyte counts and time to surgery after short-course preoperative radiotherapy for rectal cancer.
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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.

机译：直肠癌短程术前放疗后与白细胞计数和手术时间有关的术后发病率和死亡率。

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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 x 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 x 10(9) cells/L) after radiotherapy, 29 (22%) reacted abnormally (leukopenia or ratio < or =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.
机译：背景：直肠癌的术前放疗降低了局部复发率，但增加了术后并发症。术前短程放疗后术后白细胞反应受损的报道。目的是评估与白细胞反应以及放疗和手术之间的时间间隔有关的术后发病率和死亡率。材料与方法：对斯德哥尔摩一期和二期试验的患者进行回顾性分析，将患者随机接受单独手术或立即进行手术的5 x 5 Gy随机分组，确定了274例患者的术前和术后白细胞值。结果：在单独手术组（n = 144）中，除三名患者外（2％）在第一天出现白细胞增多（术后比率/术前比率> 1.0），而在第五天发生除白细胞增多（9％（6％））之外的所有反应。组（n = 130），放疗后有40（31％）个白细胞减少症（<4 x 10（9）细胞/ L），第1天和第66天有29（22％）个反应异常（白细胞减少或比率<或= 1.0） （51％）在第5天（所有p <0.001）。术前白细胞计数不影响术后发病率，但第1天的不良反应增加了败血症的风险（p <0.05）和死亡率（6/29（21％）vs. 6/101（6％），p <0.05） 。开始放疗和手术之间间隔10天或更长时间也会对死亡率产生影响; 6/17（35％）与6/113（5％），p = 0.001。在逻辑回归分析中，时间间隔和年龄是死亡率的独立预测因子。结论：短程放疗后，术后白细胞反应受损很常见，并增加了术后并发症和死亡的风险。独立于白细胞反应，比推荐的放疗-手术间隔更长的时间似乎也对术后死亡有害。

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