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POSTOPERATIVE FEVER OF UNKNOWN ORIGIN IS ASSOCIATED TO LYMPHOPENIA AFTER ESOPHAGECTOMY FOR CANCER
Ottavia De Simoni*2, Simone Mocellin1, Francesco Cavallin1, Paolo Moroni2, Luca Maria Saadeh2, Pirozzolo Pirozzolo1, Rita Alfieri1, Matteo Cagol1, Matteo Fassan3, Marco Scarpa1
1Surgical Oncology Unit, Veneto Institute of Oncology, Padova, Italy; 2Department of Surgery, Oncology and Gastroenterology, Azienda Ospedaliera - Università di Padova, Padova, Italy; 3Department of Medicine, Università degli Studi di Padova, Padova, Italy
Background
Postoperative fever of unknow origin prolongs hospital stay after esophagectomy. Esophagectomy for esophageal cancer is associated to postoperative immunosuppression inducing severely depressed monocyte and T-lymphocyte cytokine production. Remarkably, lymphopenia is an independent predictive factor for long-term survival in patients with esophageal cancer. The aim of this study was to verify the association between postoperative immune suppression and postoperative fever of unknown orign in esophageal or esophago-gastric junction cancer.
Patients and methods
One hundred ninety three consecutive patients with esophageal or esophagogastric junction cancer were enrolled in this retrospective study. Fever of unknown orign was defined as fever over 38°C not associated to positive blood or urine colture, to suspect X-ray and to anastomotic leak or fluid collection. White blood cells count, polymorph nucleate cells and lymphocytes counts were observed at preoperative time, post-operative day (POD) 1, 3 and 7. Post-operative outcome details were also retrieved. Multiple regression models were fitted to the data to test the association between potential predictor and parameters of immune suppression that resulted significant at univariate analysis.
Results
Lymphocyte count drastically reduced in PO1 [0,670/ml (IQR: 0,500 - 0,982)], compared to preopartive values [1,240/ml (IQR: 0,895-1,700)], (p<0.001). Patients with fever of unknown origin had a preoperative lymphocye count that tended to be lower than patients with fever and positive blood colture (p=0.07). On day 1 patiets who would develop fever of unknown origin had a lymphocye count lower than patients with fever and positive blood colture (p=0.02). At multivariable analysis the total dose of radiotherapy resulted to be an independent predictor of preoperative lymphocyte count and of lymphocyte count on POD1.
Conclusion
In patients with esophageal cancer post operative immunosuppression is associated to fever of unknown origin after surgery. The total amount of radiation received by the mediastinum is the only predictor of the preoperative and postoperative lymphocyte count.
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