Abstract

Objective: The extent to which neoadjuvant chemoradio-
therapy for rectal cancer influences postoperative morbid-
ity is controversial. This study investigated whether this
treatment suppresses the normal perioperative inflamma-
tory response and explored the clinical implications.
Method: Prospective databases were queried to identify
37 consecutive study patients undergoing definitive
surgery following 5-FU ⁄ capecitabine-based chemoradio-
therapy and 35 consecutive untreated control patients
operated upon for rectal or rectosigmoid cancer. Preop-
erative (< 10 days) and postoperative (< 24 h) neutrophil
counts, along with morbidity data, were confirmed
retrospectively. Univariate and multivariate analyses
assessed the apparent effect of chemoradiotherapy on
change in neutrophil count. The latter’s association with
postoperative morbidity was then examined.
Results: Sufficient data were available for 34 study and
27 control patients. Repeated-measures ANCOVA
revealed significant differences between their periopera-
tive neutrophil counts (P = 0.02). Of the other charac-
teristics which differed between the groups, only age
and tumour location were prognostically significant
regarding perioperative change in neutrophil count.
Accounting for relevant covariates, chemoradiotherapy
was significantly associated with a suppressed perioper-
ative neutrophil leucocytosis. Local postoperative com-
plications affected 25 of 61 patients, who had lower
perioperative neutrophil increases than their counter-
parts (P = 0.016).
Conclusion: Chemoradiotherapy appears to suppress the
perioperative inflammatory response, thereby increasing
susceptibility to local postoperative complications.