The effects of perioperative fluorouracil administration on convalescence and wound healing

J. M. Klausner, S. Lelcuk, M. Inbar and R. Rozin

Administration of chemotherapy is delayed by most clinicians until complete recovery from surgery because it is generally feared that cytotoxic drugs impair wound healing, reduce resistance against infection, and may hinder the recovery process. However, clinical experience is lacking. This clinical study examines the effect of perioperative administration of fluorouracil on the healing of wounds and intestinal anastomoses and the recovery process in general. Forty patients with advanced gastrointestinal tract cancers entered the study. Intravenous bolus administration of 0.5 g of fluorouracil was started during surgery. The patients underwent a variety of abdominal operations for palliation or cure. A total of 22 gastric and enteric anastomoses were performed. One half gram of fluorouracil diluted in 150 mL of 5% glucose solution was given intravenously over one hour daily for ten days postoperatively. The patients were carefully evaluated for any alteration in the postoperative recovery. Thirty-eight of the 40 patients received the full course of fluorouracil. Twenty-one patients had an uneventful postoperative course. Eighteen had mild to moderate respiratory and cardiovascular complications unrelated to fluorouracil administration. One patient died of pulmonary emboli 16 days after abdominoperineal resection. Surgical wounds healed without complications in 37 patients. One case of wound disruption occurred after sigmoidectomy. Two patients developed wound infections that healed secondarily. All 22 patients with anastomoses recovered without any evidence of leakage. Colostomies and gastrostomies functioned as anticipated. Side effects attributed to fluorouracil appeared in seven of the patients; in only two of the patients were complications life-threatening, involving bone marrow depression. All patients recovered after discontinuation of fluorouracil therapy and with supportive treatment. On the whole, the course of recovery of this group was no different than expected from patients with advanced malignant neoplasms who were undergoing extensive surgery. Based on this study, it seems that fluorouracil administration during and immediately after surgery has no deleterious effect on wound healing and recovery.