[Postoperative immunosuppression--a physiological process and source of complications. Minireview]

Area of Science:

• Immunology
• Endocrinology
• Surgical Stress Response

Context:

• Postoperative immunosuppression is a non-specific neurohumoral stress response to surgical trauma.
• Early surgical stress involves an imbalanced adrenocortical response, favoring glucocorticoid formation over dehydroepiandrosterone.
• This hormonal shift impacts the balance between T-helper 1 (TH1) and T-helper 2 (TH2) lymphocytes.

Purpose:

• To elucidate the neurohumoral mechanisms underlying postoperative immunosuppression.
• To investigate the impact of surgical stress on cell-mediated and humoral immunity.
• To explore the potential pathological consequences and therapeutic implications of this immunosuppressive state.

Summary:

• Surgical trauma induces a stress response characterized by altered glucocorticoid and dehydroepiandrosterone levels.
• This hormonal dysregulation leads to the inhibition of the TH1 response, resulting in diminished cell-mediated immunity.
• Postoperative immunosuppression and immune dysbalance are physiological, but may increase complication risks and present therapeutic targets.

Impact:

• Highlights the role of neurohumoral stress in postoperative immune dysfunction.
• Identifies potential biomarkers for evaluating postoperative complication risk.
• Suggests avenues for therapeutic interventions in high-risk surgical and oncological patients to mitigate immunosuppression.