REDUCTION OF POSTOPERATIVE IMMUNOSUPPRESSION WITH RANITIDINE IN PATIENTS WITH CANCER OF THE STOMACH OR LARGE-BOWEL

Objective: To assess the effect of ranitidine on cellular immune respo nse (and postoperative infective morbidity) in a homogeneous group of patients. Design: Prospective randomized controlled trial. Setting: Un iversity hospital, Italy. Subjects: 42 patients about to undergo curat ive resection for carcinoma of the colon, rectum, or stomach. Interven tions: Cell mediated immunity was tested 3 days before, and 4 days aft er, operation by reactions to 7 recall antigens (Multitest, Merieux). 21 patients were randomly allocated to receive ranitidine 100 mg twice daily intravenously from the day before operation until the third pos toperative day. Main outcome measures: Comparison of the number of rea ctive patients and number of positive antigens before and after operat ion; and correlation between reactivity and incidence of postoperative infective complications. Results: The median (range) skin test scores preoperatively were: ranitidine group 8.5 (0-17), and control group 1 0 (0-19). The postoperative figures were 7 (0-28) and 4.5 (0-15.5) res pectively. The corresponding numbers of positive antigens were 1 (0-4) an 3 (0-4) compared with 1 (0-5) and 1 (0-3). The changes in the scor es did not seem to be influenced by blood transfusion, serum albumin c oncentration, age of the patient, or type of tumour. Two patients died in the ranitidine group (pulmunary embulus, n = 1, necrotising pancre atitis, n = 1) and there were 4 wound infections. There were no deaths in the control group, one intra-abdominal abscess, and 8 wound infect ions. Median hospital stay was similar, 10 (8-16) in the ranitidine gr oup, and 11 (5-20) in the control group. Conclusion: Ranitidine had a beneficial effect on cell-mediated immunity as it seemed to prevent th e usual postoperative reduction in reactivity, but there was no signif icant difference in the incidence of infective complications though it was lower in the ranitidine group.