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Neutrophil phenotypes quantify tissue damage caused by major surgery.

Emma J de Fraiture1, Ted Reniers2,3, Nathalie E W Vreeman2

  • 1Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands.

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Summary

Major surgery causes significant changes in neutrophil phenotypes, indicating acute inflammation. Pancreatic surgery elicits a more pronounced innate immune response than cardiac surgery, suggesting neutrophil phenotyping as a potential biomarker.

Keywords:
CABGimmune responseinflammationsurgerysurgery for pancreatic cancertissue damage

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Area of Science:

  • Immunology
  • Surgical Science
  • Hematology

Background:

  • Major surgery can induce an excessive innate immune response, leading to immune suppression and increased infection risk.
  • Neutrophil phenotype alterations correlate with the severity of the innate immune response post-surgery.

Purpose of the Study:

  • To investigate the impact of major surgery on neutrophil phenotypes using fully automated flow cytometry.
  • To compare the innate immune response to pancreaticoduodenectomy versus coronary artery bypass grafting (CABG).

Main Methods:

  • Prospective single-center cohort study (BIGPROMISE) involving adult patients undergoing pancreaticoduodenectomy or on-pump CABG.
  • Blood samples collected preoperatively and immediately postoperatively.
  • Neutrophil phenotypes analyzed via automated flow cytometry with rapid (<30 min) analysis.

Main Results:

  • Significant postoperative changes in neutrophil subsets observed in all patients, indicating acute systemic inflammation.
  • Pancreatic surgery group exhibited a more extensive inflammatory response (83% in Category 5) compared to the CABG group (29%).
  • Minimal preoperative neutrophil heterogeneity was noted.

Conclusions:

  • This is the first study utilizing fully automated flow cytometry for perioperative neutrophil phenotype monitoring.
  • Findings reveal a more pronounced innate immune response and neutrophil activation following pancreatic surgery than cardiac surgery.
  • Neutrophil phenotyping may serve as a valuable biomarker for patient stratification and management, pending validation in larger studies.