The new way of postoperative pulmonary complications prophylaxis in oesophageal cancer surgery

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Objective

The efficacy of Neupogen (granulocyte colony-stimulating factor) in prevention of pulmonary complications after transthoracic subtotal oesophagectomy (TSE).

Design

Prospective randomized double-blind clinical trial.

Materials

Twenty-eight oesophageal cancer patients were treated with Neupogen 5 μg/kg s.c. one day prior surgery, and on the 1st and 2nd days after TSE. Thirty-five patients received placebo on the same days. No one patient was basically neutropenic. The therapeutic regimen, including choice of antibacterial agents, was similar in both groups. The incidence of postoperative pneumonia (according to CPIS criteria), sepsis and multiple organ failure syndrome (MOFS) was registered.

Results

Four (14%) patients in the Neupogen group developed pneumonia postoperatively. There were no cases of sepsis and MOFS in this group. White blood cells (WBC) in peripheral blood samples on the third postoperative day reached 24.5± 2.9×10³ per μl.

On the contrary, severe pneumonia occurred in 16 (46%) patients of control group including 5 (14%) cases of sepsis and MOFS. WBC level was 8.1± 3.4 ×10³ per μl. The difference between the two groups was significant (P<0.05).

Conclusion

The stimulation of granulocytes with Neupogen decreases greatly the incidence of pneumonia and sepsis after transthoracic oesophageal resections in cancer patients, and probably after extended cancer surgical procedures in general.