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None.Between December 2001 and March 2003 116 patients with cT3NxM0 rectal cancer were treated withpreoperative 5 × 5 G radiotherapy in whom resection withprimary anastomosis was performed. All patients had blood morphology sampledprior to radiotherapy, after the radiotherapy andprior to surgery and within 24 hours following surgery.Analysis of the results indicates that there are two distinctive patterns of neutrocyte number responses as a result of radiotherapy. The first group (A), as expected, experiences a reduction in absolute neutrocyte count (N = 79), but in 37 patients there was increase in number of neutrocytes observed (B). The number of postoperative complications was higher in group B than in A (46.6% vs 26.6%, P < 0.001), as well as the number of anastomotic leaks (18.9% vs 11.3%). Additionally, this group experienced inferior 5-year cancer specific survival (73.2% vs 89.9%, P < 0.01). The multiparametric Cox analysis for survival indicated that the independant variables for survival in this group were neutrocyte count following radiotherapy, % change in neutrocyte count following radiotherapy,presence of anastomotic leaks andpresence of nodal involvement.Patients with increased neutrocyte count followingpreoperative 5 × 5 G radiotherapy in resectable rectal cancer should be re-evaluated for response in larger clinical trials.