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Changes in immune function following surgery for esophageal carcinoma
T Tashiro1, H Yamamori, K Takagi
1Kamitsuga General Hospital, Tochigi, Japan.
Nutrition (Burbank, Los Angeles County, Calif.)
|September 29, 1999
Summary
Esophageal surgery triggers immunosuppression and a hyperinflammatory response, unlike gastric surgery. This immune suppression after esophagectomy correlates with increased cortisol and interleukin-6 (IL-6) levels.
Area of Science:
- Immunology
- Surgical Oncology
- Critical Care Medicine
Background:
- Surgical injury can alter immune function, potentially leading to infectious complications and organ dysfunction.
- The specific surgical procedures that induce immunosuppression in clinical practice remain unclear.
- Understanding the immune response to different surgical stresses is crucial for managing critically ill patients.
Purpose of the Study:
- To compare the stress response and immune function following esophagectomy (highly-stressed) versus gastric surgery (moderately-stressed).
- To investigate the relationship between surgical stress markers, immune cell function, and inflammatory markers.
- To determine if specific surgical procedures induce immunosuppression.
Main Methods:
- Measured serum interleukin-6 (IL-6), C-reactive protein (CRP), cortisol, total protein, albumin, and rapid turnover protein in 40 esophagectomy and 39 gastrectomy patients.
- Assessed ConA- and PHA-stimulated lymphocyte proliferation and immunoglobulin (IgA, IgG, IgM) levels.
- Utilized total parenteral nutrition (TPN) for all patients.
- Collected samples preoperatively and at various time points postoperatively (up to 21 days).
Main Results:
- Esophagectomy patients showed significantly higher peak IL-6, CRP, and cortisol levels compared to gastrectomy patients.
- Cell-mediated immunity, measured by lymphocyte proliferation, significantly decreased 7 days after esophagectomy but remained unchanged after gastrectomy.
- Immunosuppression correlated with elevated serum cortisol and was preceded by a rise in IL-6.
- Immunoglobulin levels and nutritional markers (serum protein, albumin) did not differ significantly between the groups postoperatively.
Conclusions:
- Esophageal surgery induces a cell-mediated immunosuppression, preceded by a hyperinflammatory response.
- Gastric surgery does not appear to cause significant cell-mediated immunosuppression.
- IL-6 and cortisol levels are key indicators of the stress response and subsequent immune changes following major surgery.