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Cell response to surgery.

Niamh Ni Choileain1, H Paul Redmond

  • 1Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland. nncl@eircom.net

Archives of Surgery (Chicago, Ill. : 1960)
|November 23, 2006
PubMed
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Major surgery profoundly alters host immunity, leading to inflammatory and anti-inflammatory responses that increase infection risk. Early therapeutic strategies targeting immune balance are crucial for preventing severe complications.

Area of Science:

  • Immunology
  • Surgical Pathology
  • Critical Care Medicine

Background:

  • Major surgery triggers significant alterations in the host immune system.
  • Perioperative immune dysfunction can lead to increased susceptibility to infections and organ dysfunction.

Purpose of the Study:

  • To describe the immunological changes induced by major surgery.
  • To evaluate therapeutic strategies for mitigating perioperative immune dysfunction.

Main Methods:

  • Comprehensive literature review of MEDLINE, EMBASE, and Cochrane databases.
  • Inclusion of experimental and clinical studies on cellular immune responses to surgery.
  • Analysis of articles and case reports detailing immune dysfunction post-surgical trauma.

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Main Results:

  • Major surgery induces a biphasic immune response: initial systemic inflammatory response syndrome (SIRS) followed by compensatory anti-inflammatory response syndrome (CARS).
  • This immune imbalance predisposes patients to opportunistic infections, multiple organ dysfunction syndrome (MODS), and mortality.
  • Experimental data suggest immunomodulatory agents (e.g., interferon gamma, G-CSF, indomethacin, pentoxifylline) may treat SIRS and prevent MODS.

Conclusions:

  • Surgical trauma causes significant immunological dysfunction.
  • Therapeutic strategies should focus on restoring immune homeostasis by addressing the proinflammatory-anti-inflammatory imbalance.
  • Preventive measures against MODS are essential due to the lack of effective treatments.