Perioperative treatment with filgrastim stimulates granulocyte function and reduces infectious complications after esophagectomy.
We investigated the effects of recombinant G-CSF (Filgrastim) on the function of neutrophils and the rate of infectious complications in an open-label, nonrandomized study of patients with esophageal cancer undergoing esophagectomy. In this single-center phase-II trial 20 sequential patients (19 evaluable) received Filgrastim at standard doses (300 microg or 480 microg) subcutaneously for 2 days prior to and up to 7 days after surgery. The phagocytotic activity of neutrophils and the oxidative burst in the study group and in an experimental control group (n=27) were measured on days -2, 2, and 10. Neutrophil function was enhanced in the Filgrastim-treated group by factor 1.2 for phagocytosis (p=0.016) and 1.4 for oxidative burst (p)=0.154). Leukocyte counts increased from 7.6 x 10(9)/l (day -2) to a maximum of 45 x 10(9)/l on day 6. No infection was reported in the study group (mean age 59.7 years; 13 men, seven women) up to 10 days after surgery. In contrast, 23 patients (29.9%) in a historical control group (mean age 56 years; 67 men, ten women) treated at the same center developed infections within the first 10 days (p = 0.008). In addition, no postoperative deaths occurred in the study group, compared with 9.1% in the group of historical controls. Thus, in this study, administration of Filgrastim stimulated neutrophil function in patients undergoing esophagectomy, and it might be effective in reducing infectious complications related to the surgical procedure.
Schäfer
H
H
Klinik und Poliklinik fur Visceral- und Gefässchirurgie, Universität zu Köln, Cologne, Germany.
Hübel
K
K
Bohlen
H
H
Mansmann
G
G
Hegener
K
K
Richarz
B
B
Oberhäuser
F
F
Wassmer
G
G
Hölscher
A H
AH
Pichlmaier
H
H
Diehl
V
V
Engert
A
A
D000328:Adult; D000368:Aged; D016207:Cytokines / Q000097:blood; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D006098:Granulocytes / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000502:physiology; D019990:Perioperative Care; D010587:Phagocytosis; D011994:Recombinant Proteins / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000517:prevention & control*; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D016207:Cytokines; D016209:Interleukin-8; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim