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Effect of preoperative prophylaxis with filgrastim in cancer neck dissection
Author(s) -
Wenisch,
Werkgartner,
Sailer,
Patruta,
; Krause,
Daxboeck,
Parschalk
Publication year - 2000
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1046/j.1365-2362.2000.00643.x
Subject(s) - medicine , filgrastim , perioperative , surgery , anesthesia , staphylococcus aureus , cancer , gastroenterology , neutropenia , chemotherapy , biology , bacteria , genetics
Background Cancer surgery is known to lead to a deterioration in host defence mechanisms and an increase in susceptibility to infection after operation. Filgrastim enhances important antimicrobial functions of neutrophils including chemotaxis, phagocytosis and oxidative killing mechanisms. Methods The effects of additional (all patients received perioperative 3 ′ 25 mg kg −1 cefotiam and 1 ′ 20 mg kg −1 metronidazole) preoperative prophylaxis with filgrastim (5 μg kg −1 12 h prior to surgery plus 5 μg kg −1 0 h prior to surgery) on neutrophil phagocytosis and reactive oxygen radical production and postoperative infections in 24 patients undergoing cancer neck dissection were studied. Phagocytic capacity was assessed by measuring the uptake of fluorescein isothiocyanate‐labelled Escherichia coli and Staphylococcus aureus by flow cytometry. Reactive oxygen generation after phagocytosis was estimated by determining the amount of dihydrorhodamine 123 converted to rhodamine 123, intracellularly. Results In the filgrastim‐treated patients a higher neutrophil phagocytic capacity was seen intraoperatively, and 1–5 days postoperative, but not prior to surgery. Reactive oxygen radical production was significantly higher in filgrastim‐treated patients prior to surgery, intraoperative and postoperative (1–5 days). 2/12 (17%) patients had postoperative infections in the filgrastim group and 9/12 (75%) patients had infections in the placebo group ( P < 0.001). In particular, wound infections were recorded more often in the placebo group (1/12 vs. 6/12; P = 0.004). Conclusion We conclude that filgrastim enhances perioperative neutrophil function and could be useful in the prophylaxis of postoperative wound infections in patients undergoing cancer neck dissection.