Johnson Louis Banka, Jorgensen Lars N, Adawi Diya, Blomqvist Peter, Asklöf Göran B Son, Gottrup Finn, Jeppsson Bengt
Department of Surgery, Malmö University Hospital , Lund University, Malmö, Sweden.
Dis Colon Rectum. 2005 Aug;48(8):1573-80. doi: 10.1007/s10350-005-0066-0.
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.
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.
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.
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.
直肠癌术前大剂量放疗可降低局部复发率并提高总生存率。然而，不同程度的不良反应包括伤口愈合受损和局部感染。本研究调查了术前大剂量放疗对接受或未接受辅助放疗的原发性直肠癌组皮下胶原蛋白蓄积的影响。
42例符合条件的患者纳入研究，这些患者接受了全直肠系膜切除术，部分接受了放疗。在手术前10天（放疗开始前3天）将聚四氟乙烯管植入手臂。在手术前一天取出植入物。在手术前插入新的植入物，并在手术后10天取出。测量植入物中羟脯氨酸和脯氨酸的含量，并计算羟脯氨酸/脯氨酸比值，作为相对于蛋白质的沉积胶原蛋白的指标。记录失血量、术后并发症以及血红蛋白、白细胞和白蛋白的血液水平。
两组在Dukes分期、年龄和体重指数方面相似。放疗后39%的患者发生感染并发症，而未接受放疗的组为16%。与未发生感染的放疗患者相比，发生感染并发症的放疗患者的羟脯氨酸/脯氨酸比值显著降低（P = 0.037）。与单纯手术组相比，放疗组术前和术后白细胞计数显著降低。
大剂量短期放疗对胶原蛋白蓄积没有全身影响，但在感染患者中表现出显著降低。放疗还会损害白细胞生成并增加术后感染并发症发生率。
