The effect of preoperative radiotherapy on systemic collagen deposition and postoperative infective complications in rectal cancer patients.
OBJECTIVE
Preoperative, high-dose radiotherapy for rectal cancer reduces local recurrence rates and improves overall survival. However, adverse effects in varying degrees include impaired wound healing and local infection. This study investigates the influence of preoperative, high-dose radiotherapy on subcutaneous accumulation of collagen in a primary rectal cancer group operated on with or without adjuvant radiotherapy.


METHODS
Forty-two eligible patients who underwent total mesorectal excision surgery with or without radiotherapy were included in the study. Polytetrafluoroethylene tubings were implanted in the arm ten days before surgery (three days before the start of radiotherapy). Implants were extracted the day before surgery. New implants were inserted before surgery and were extracted ten days after surgery. The hydroxyproline and proline contents of the implants were measured and the hydroxyproline/proline ratio was calculated as a measure for deposited collagen relative to protein. Blood loss, postoperative complications, and blood levels of hemoglobin, leukocytes, and albumin were recorded.


RESULTS
The two groups were similar in relation to Dukes stage, age, and body mass index. Infectious complications developed in 39 percent of patients after radiotherapy compared with 16 percent in the nonirradiated group. In the irradiated patients with infective complications we found a significant decrease in the hydroxyproline/proline ratio compared with that of irradiated patients without infections (P = 0.037). There was a significant decrease in the leukocyte count preoperatively and postoperatively in the irradiated group compared with surgery alone.


CONCLUSIONS
High-dose, short-term radiotherapy does not have a systemic effect on collagen accumulation, but a significant reduction is manifested in infected patients. Radiotherapy also impairs leukocyte production and increases the postoperative infective complication rate.
Johnson
Louis Banka
LB
Department of Surgery, Malmö University Hospital , Lund University, Malmö, Sweden.
Jorgensen
Lars N
LN
Adawi
Diya
D
Blomqvist
Peter
P
Asklöf
Göran B Son
GB
Gottrup
Finn
F
Jeppsson
Bengt
B
D000368:Aged; D016063:Blood Loss, Surgical; D003094:Collagen / Q000378:metabolism / Q000528:radiation effects*; D005260:Female; D006454:Hemoglobins / Q000032:analysis / Q000528:radiation effects; D006801:Humans; D006909:Hydroxyproline / Q000032:analysis / Q000528:radiation effects; D007440:Intubation / Q000295:instrumentation; D007958:Leukocyte Count; D007962:Leukocytes / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011300:Preoperative Care; D011392:Proline / Q000032:analysis / Q000528:radiation effects; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012709:Serum Albumin / Q000032:analysis; D012867:Skin / Q000378:metabolism / Q000528:radiation effects*; D013530:Surgical Wound Infection / Q000209:etiology*
D006454:Hemoglobins; D012709:Serum Albumin; D011138:Polytetrafluoroethylene; D003094:Collagen; D011392:Proline; D006909:Hydroxyproline