Effect of preoperative prophylaxis with filgrastim in cancer neck dissection

Background Cancer surgery is known to lead to a deterioration in host defen ce mechanisms and an increase in susceptibility to infection after operatio n. Filgrastim enhances important antimicrobial functions of neutrophils inc luding chemotaxis, phagocytosis and oxidative killing mechanisms. Methods The effects of additional (all patients received perioperative 3 ' 25 mg kg(-1) cefotiam and 1 ' 20 mg kg(-1) metronidazole) preoperative prop hylaxis with filgrastim (5 mu g kg(-1) 12 h prior to surgery plus 5 mu g kg (-1) 0 h prior to surgery) on neutrophil phagocytosis and reactive oxygen r adical production and postoperative infections in 24 patients undergoing ca ncer neck dissection were studied. Phagocytic capacity was assessed by meas uring the uptake of fluorescein isothiocyanate-labelled Escherichia coli an d Staphylococcus aureus by flow cytometry. Reactive oxygen generation after phagocytosis was estimated by determining the amount of dihydrorhodamine 1 23 converted to rhodamine 123, intracellularly. Results In the filgrastim-treated patients a higher neutrophil phagocytic c apacity was seen intraoperatively, and 1-5 days postoperative, but not prio r to surgery. Reactive oxygen radical production was significantly higher i n filgrastim-treated patients prior to surgery, intraoperative and postoper ative (1-5 days). 2/12 (17%) patients had postoperative infections in the f ilgrastim group and 9/12 (75%) patients had infections in the placebo group (P < 0.001). In particular, wound infections were recorded more often in t he placebo group (1/12 vs. 6/12; P = 0.004). Conclusion We conclude that filgrastim enhances perioperative neutrophil fu nction and could be useful in the prophylaxis of postoperative wound infect ions in patients undergoing cancer neck dissection.