The Risks of Perioperative Chemotherapy in Large-Bowel Cancer Surgery

Abstract

The approach of administering perioperative chemotherapy as an adjuvant to curative surgery in large-bowel cancer is really not a modern one, as it might seem to be today. Based on the observation of free malignant cells circulating in the blood during operation (Fisher and Turnbull 1955; Moore et al. 1957), several attemps have been made to treat these cancer cells prophylactically at the time of operation. In the mid-1950s, Warren Cole’s group in Chicago initiated the idea of perioperative chemotherapy (Morales et al. 1957), supposing that cancer cells might be more vulnerable to the action of anticancer agents if given on the day of the operation, before these “loose” cells develop a blood supply. They stated: “Improvement in the 5-year survival rate of the surgical treatment of cancer during the past 10 or 15 years has been made primarily by increasing the extent of the operation. However, there is no hope that further improvement can be expected from this phase of the operation, because we are now approaching anatomical limits in respect to the amount of tissue that can be removed.” This may still be true today. Following experimental research in rats, in March 1956 Cole’s group started the clinical use of nitrogen mustard given to patients at the time of operation. A dose of 0.1 mg/kg body weight was given both through the portal venous system and into the peritoneal cavity during operation, and then IV on postoperative days 1 and 2.