G-CSF verbessert das postoperative Outcome von Hochrisikopatienten nach Operation aufgrund eines kolorektalen Karzinoms

Introduction: Recombinant human granulocyte colony stimulating factor (G-CSF, filgrastim) is a cytokine which is commonly used to prevent neutropenia and its complications in tumor patients. Recently in a systematic review was shown that G-CSF did not alter the survival rate and number of remissions in patients with malignant lymphoma, but G-CSF showed a positive influence on accompanying diseases such as infections [1]. The aim of this trial was to test the effectiveness of a G-CSF prophylaxis in high risk patients with regard to improvement of the postoperative outcome [2]. Methods: To analyze this question we performed a prospective, randomized, multicenter trial with 80 high risk patients (ASA 3 and 4) and colorectal cancer surgery [2]. The patients were randomized in a 2 × 2 factorial design to: 1) G-CSF plus cefuroxime/metronidazole (Cef/Met), 2) G-CSF plus ofloxacin/ metronidazole (Ofl/Met), 3) placebo plus Cef/Met, and 4) placebo plus Ofl/Met. G-CSF (300 µg) was injected subcutaneously 12 h before operation, and 12 and 36 h after surgery. Quality of life (QoL) [4] was assessed before operation, at discharge, 2 and 6 months postoperatively with the EORTC-QLQ-C30 and the colorectal cancer module C38 [4]. Results: In the study time of 2 years 162 patients with ASA 3 and 4 had an left-sided colorectal cancer resection in the three study centers. From this 162 patients 80 fulfilled the inclusion criteria. Baseline demographic and physiological data (age, gender, ASA, nutritional status, concomitant disease, type of operation) were not different between the groups. At hospital discharge global QoL, family life, negative affect, physical functioning, cognitive functioning was best and pain lowest in the G-CSF plus cef/met group (optimum 100 QoL points) (¤ Table 1). Furthermore patients in the cef/met group had the shortest length of hospital stay and the fewest numbers of complications. Conclusions: G-CSF prophylaxis improves the postoperative quality of life in high risk patients with colorectal cancer resections. This G-CSF effect is dependent on the antibiotic used. Clinical complexity interactions are decisive for the effectivity of this prophylaxis.