TY - JOUR
T1 - Immune responses and prediction of major infection in patients undergoing transhiatal or transthoracic esophagectomy for cancer
AU - van Sandick, Johanna W.
AU - Gisbertz, Suzanne S.
AU - ten Berge, Ineke J. M.
AU - Boermeester, Marja A.
AU - van der Pouw Kraan, Tineke C. T. M.
AU - Out, Theo A.
AU - Obertop, Hugo
AU - van Lanschot, J. Jan B.
PY - 2003
Y1 - 2003
N2 - Objective To investigate alterations in immune responses after transhiatal versus transthoracic esophageal resection and to evaluate the role of preoperative immune functions in predicting postoperative infectious complications. Summary Background Data Impaired immune defense is associated with a decreased resistance to infection. Patients undergoing esophageal resection via a transhiatal or transthoracic approach are prone to develop infectious complications. There are no randomized data on immune responses after two major surgical interventions. Methods The study group consisted of 20 patients who were randomly allocated to a limited transhiatal or extended transthoracic esophagectomy for cancer. Blood samples were taken before the operation and at regular intervals thereafter from day 1 to day 10. Monocyte and T-helper type 1 (Th1) and type 2 (Th2) lymphocyte functions were assessed in stimulated whole blood cultures. Results Both surgical groups had severely depressed in vitro production of interleukin (IL)-12, IL-10, interferon-gamma, IL-2, IL-4, and IL-13 on postoperative day 1. Depression of Th2-type cytokine production was more profound after transthoracic than after transhiatal esophagectomy (IL-4, P = .005; IL-13, P = .007). Postoperative reduction in Th1-type cytokine production was similar between the two groups (interferon-gamma, P = .40; IL-2, P = .06). Irrespective of the surgical approach, patients who developed major infectious complications after surgery presented with a diminished T-cell cytokine production before the operation compared to those who had a relatively uneventful recovery (IL-4, P = .045; interferon-gamma, P = .064). In regression analysis, the occurrence of postoperative major infection was best predicted by increased duration of anesthesia (P <.0001) and low preoperative interferon-γ production (P = .006). Conclusions Both transhiatal and transthoracic esophagectomy induced severely depressed monocyte and T-lymphocyte cytokine production. The extent of the surgical procedure had a differential immunosuppressive impact on Th2-type but not on Th1-type cell activity, indicating that the two Th pathways were downregulated through distinct mechanisms. Preoperative interferon-γ determination would be useful to anticipate the occurrence of postoperative major infectious complications
AB - Objective To investigate alterations in immune responses after transhiatal versus transthoracic esophageal resection and to evaluate the role of preoperative immune functions in predicting postoperative infectious complications. Summary Background Data Impaired immune defense is associated with a decreased resistance to infection. Patients undergoing esophageal resection via a transhiatal or transthoracic approach are prone to develop infectious complications. There are no randomized data on immune responses after two major surgical interventions. Methods The study group consisted of 20 patients who were randomly allocated to a limited transhiatal or extended transthoracic esophagectomy for cancer. Blood samples were taken before the operation and at regular intervals thereafter from day 1 to day 10. Monocyte and T-helper type 1 (Th1) and type 2 (Th2) lymphocyte functions were assessed in stimulated whole blood cultures. Results Both surgical groups had severely depressed in vitro production of interleukin (IL)-12, IL-10, interferon-gamma, IL-2, IL-4, and IL-13 on postoperative day 1. Depression of Th2-type cytokine production was more profound after transthoracic than after transhiatal esophagectomy (IL-4, P = .005; IL-13, P = .007). Postoperative reduction in Th1-type cytokine production was similar between the two groups (interferon-gamma, P = .40; IL-2, P = .06). Irrespective of the surgical approach, patients who developed major infectious complications after surgery presented with a diminished T-cell cytokine production before the operation compared to those who had a relatively uneventful recovery (IL-4, P = .045; interferon-gamma, P = .064). In regression analysis, the occurrence of postoperative major infection was best predicted by increased duration of anesthesia (P <.0001) and low preoperative interferon-γ production (P = .006). Conclusions Both transhiatal and transthoracic esophagectomy induced severely depressed monocyte and T-lymphocyte cytokine production. The extent of the surgical procedure had a differential immunosuppressive impact on Th2-type but not on Th1-type cell activity, indicating that the two Th pathways were downregulated through distinct mechanisms. Preoperative interferon-γ determination would be useful to anticipate the occurrence of postoperative major infectious complications
U2 - https://doi.org/10.1097/00000658-200301000-00006
DO - https://doi.org/10.1097/00000658-200301000-00006
M3 - Article
C2 - 12496528
SN - 0003-4932
VL - 237
SP - 35
EP - 43
JO - Annals of surgery
JF - Annals of surgery
IS - 1
ER -