Release of band cells from the bone marrow is impaired by preoperative chemoradiation in patients with esophageal carcinoma: Increased risk of postoperative pneumonia

Purpose: To examine the difference in hematological data and postsurgical course after esophagectomy between patients receiving preoperative chemoradiation and patients without preoperative treatment. Methods: Twenty-two patients with squamous cell carcinoma of the esophagus who underwent esophagectomy during the past 2 years were retrospectively analyzed in the study. Six patients had preoperative chemoradiation (CRT group) and 16 patients had no preoperative treatment (non-CRT group). The hematological data, postoperative course, and surgical complications were compared between the two groups. Results: Patients in the CRT group were given cisplatin and 5-FU (143 and 6,000 mg on average, respectively) plus an average of 35 Gy of radiation. Although the neutrophil count did not show a significant difference between the two groups, the band cell count was lower in the CRT group compared with the non-CRT group on postoperative day 1 (P<0.05). Postoperative pneumonia was detected in three patients (50%) from the CRT group versus none of the non-CRT group. Conclusion: Preoperative CRT may be a risk factor for postoperative pneumonia in patients with esophageal carcinoma who undergo esophagectomy. The normal bone marrow response of releasing band cells from the postmitotic marrow pool after surgery could be disturbed by CRT, which might contribute to an increase in later pulmonary complications.