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Postoperative leukopenia after cytoreductive surgery and hypertherm intraperitoneal chemotherapy for colorectal carcinomatosis- causes and implication on outcomes in a population-based study

Lepsenyi, Mattias LU orcid ; Valdimarsson, Valentinus LU orcid ; Algethami, Nader LU ; Thorlacius, Henrik LU ; Ghanipour, Lana ; Cashin, Peter ; Asplund, Dan ; Lindskog, Elinor Bexe ; Palmer, Gabriella Jansson and Nilsson, Per J , et al. (2025) In World Journal of Surgical Oncology 23. p.1-11
Abstract

BACKGROUND: Leukocytes have been reported to have tumor stimulating effects in colorectal cancer, among other malignancies. In line with this, earlier research has shown improved disease-free survival in patients with postoperative neutropenia compared to non-neutropenic patients following cytoreductive surgery (CRS) and hypertherm intraperitoneal chemotherapy (HIPEC).

AIM: To evaluate the impact of postoperative leukopenia after CRS and HIPEC on recurrence rate, survival, and risk of complications.

METHODS: All CRS and HIPEC-procedures for colorectal adenocarcinoma in the national Swedish HIPEC-registry since 2015 and local registries in Uppsala and Malmö since 2003 until December 31st, 2021, were included (n = 921).... (More)

BACKGROUND: Leukocytes have been reported to have tumor stimulating effects in colorectal cancer, among other malignancies. In line with this, earlier research has shown improved disease-free survival in patients with postoperative neutropenia compared to non-neutropenic patients following cytoreductive surgery (CRS) and hypertherm intraperitoneal chemotherapy (HIPEC).

AIM: To evaluate the impact of postoperative leukopenia after CRS and HIPEC on recurrence rate, survival, and risk of complications.

METHODS: All CRS and HIPEC-procedures for colorectal adenocarcinoma in the national Swedish HIPEC-registry since 2015 and local registries in Uppsala and Malmö since 2003 until December 31st, 2021, were included (n = 921). Patients who did not complete a full CRS and HIPEC procedure (n = 99), had incomplete macroscopic cytoreduction (n = 25) or a lack of information on leukocyte count (n = 213) were excluded, resulting in 584 analyzed cases. Primary outcome was overall recurrence rate. Secondary outcomes were overall survival, recurrence-free survival, and perioperative complications.

RESULTS: Postoperative leukopenia was observed in 54 (9.2%) cases of which 32 (5.5%) developed severe leukopenia. No differences in patient characteristics were noted between those with or without leukopenia. There were no differences in 3-year recurrence rate, overall survival or 3-year recurrence-free survival, between the groups. Neoadjuvant chemotherapy treatment, HR 1.32 (95% CI: 1.02-1.71), higher PCI-score, HR 1.50 (95% CI: 1.09-2.05) and higher pN-stage HR 2.52 (95% CI: 1.74-3.65) were associated with higher 3-year recurrence rate. 3-year mortality was associated with neoadjuvant chemotherapy treatment, HR 1.82 (95% CI: 1.06-3.11), severe postoperative complication, HR 2.39 (95% CI: 1.39-4.13) and high PCI-score, HR 2.60 (95% CI: 1.31-5.14). Treatment with combined oxaliplatin/irinotecan, HR 12.34 (95% CI: 4.51-33.74) was associated with developing postoperative leukopenia. Longer operation time, HR 2.30 (95% CI: 1.55-3.42), and severe leukopenia, HR 3.50 (95% CI: 1.25-9.77) were associated with postoperative complication.

CONCLUSIONS: Postoperative leukopenia did not impact recurrence rate or long-term survival in a statistically significant manner. Neoadjuvant chemotherapy and high PCI-score were associated with both recurrent disease and mortality within 3 years.

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publication status
published
subject
keywords
Humans, Leukopenia/etiology, Female, Male, Colorectal Neoplasms/therapy, Cytoreduction Surgical Procedures/adverse effects, Middle Aged, Hyperthermic Intraperitoneal Chemotherapy/adverse effects, Aged, Postoperative Complications/etiology, Survival Rate, Neoplasm Recurrence, Local/pathology, Prognosis, Sweden/epidemiology, Follow-Up Studies, Peritoneal Neoplasms/therapy, Registries, Adenocarcinoma/therapy, Antineoplastic Combined Chemotherapy Protocols/adverse effects, Adult, Combined Modality Therapy
in
World Journal of Surgical Oncology
volume
23
article number
173
pages
1 - 11
publisher
BioMed Central (BMC)
external identifiers
  • pmid:40301901
  • scopus:105003882467
ISSN
1477-7819
DOI
10.1186/s12957-025-03821-2
language
English
LU publication?
yes
additional info
© 2025. The Author(s).
id
736593dc-7947-407b-b2a1-e96d5a832708
date added to LUP
2025-05-26 15:41:43
date last changed
2025-06-10 04:42:55
@article{736593dc-7947-407b-b2a1-e96d5a832708,
  abstract     = {{<p>BACKGROUND: Leukocytes have been reported to have tumor stimulating effects in colorectal cancer, among other malignancies. In line with this, earlier research has shown improved disease-free survival in patients with postoperative neutropenia compared to non-neutropenic patients following cytoreductive surgery (CRS) and hypertherm intraperitoneal chemotherapy (HIPEC).</p><p>AIM: To evaluate the impact of postoperative leukopenia after CRS and HIPEC on recurrence rate, survival, and risk of complications.</p><p>METHODS: All CRS and HIPEC-procedures for colorectal adenocarcinoma in the national Swedish HIPEC-registry since 2015 and local registries in Uppsala and Malmö since 2003 until December 31st, 2021, were included (n = 921). Patients who did not complete a full CRS and HIPEC procedure (n = 99), had incomplete macroscopic cytoreduction (n = 25) or a lack of information on leukocyte count (n = 213) were excluded, resulting in 584 analyzed cases. Primary outcome was overall recurrence rate. Secondary outcomes were overall survival, recurrence-free survival, and perioperative complications.</p><p>RESULTS: Postoperative leukopenia was observed in 54 (9.2%) cases of which 32 (5.5%) developed severe leukopenia. No differences in patient characteristics were noted between those with or without leukopenia. There were no differences in 3-year recurrence rate, overall survival or 3-year recurrence-free survival, between the groups. Neoadjuvant chemotherapy treatment, HR 1.32 (95% CI: 1.02-1.71), higher PCI-score, HR 1.50 (95% CI: 1.09-2.05) and higher pN-stage HR 2.52 (95% CI: 1.74-3.65) were associated with higher 3-year recurrence rate. 3-year mortality was associated with neoadjuvant chemotherapy treatment, HR 1.82 (95% CI: 1.06-3.11), severe postoperative complication, HR 2.39 (95% CI: 1.39-4.13) and high PCI-score, HR 2.60 (95% CI: 1.31-5.14). Treatment with combined oxaliplatin/irinotecan, HR 12.34 (95% CI: 4.51-33.74) was associated with developing postoperative leukopenia. Longer operation time, HR 2.30 (95% CI: 1.55-3.42), and severe leukopenia, HR 3.50 (95% CI: 1.25-9.77) were associated with postoperative complication.</p><p>CONCLUSIONS: Postoperative leukopenia did not impact recurrence rate or long-term survival in a statistically significant manner. Neoadjuvant chemotherapy and high PCI-score were associated with both recurrent disease and mortality within 3 years.</p>}},
  author       = {{Lepsenyi, Mattias and Valdimarsson, Valentinus and Algethami, Nader and Thorlacius, Henrik and Ghanipour, Lana and Cashin, Peter and Asplund, Dan and Lindskog, Elinor Bexe and Palmer, Gabriella Jansson and Nilsson, Per J and Syk, Ingvar}},
  issn         = {{1477-7819}},
  keywords     = {{Humans; Leukopenia/etiology; Female; Male; Colorectal Neoplasms/therapy; Cytoreduction Surgical Procedures/adverse effects; Middle Aged; Hyperthermic Intraperitoneal Chemotherapy/adverse effects; Aged; Postoperative Complications/etiology; Survival Rate; Neoplasm Recurrence, Local/pathology; Prognosis; Sweden/epidemiology; Follow-Up Studies; Peritoneal Neoplasms/therapy; Registries; Adenocarcinoma/therapy; Antineoplastic Combined Chemotherapy Protocols/adverse effects; Adult; Combined Modality Therapy}},
  language     = {{eng}},
  month        = {{04}},
  pages        = {{1--11}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{World Journal of Surgical Oncology}},
  title        = {{Postoperative leukopenia after cytoreductive surgery and hypertherm intraperitoneal chemotherapy for colorectal carcinomatosis- causes and implication on outcomes in a population-based study}},
  url          = {{http://dx.doi.org/10.1186/s12957-025-03821-2}},
  doi          = {{10.1186/s12957-025-03821-2}},
  volume       = {{23}},
  year         = {{2025}},
}