Objectives: The body's response to stress is comprised of two opposing reactions, namely inflammation and immunosuppression. The balance between these two reactions not only changes over time, but also varies among different cells or organs. Limited information is available regarding the cytokine balance of circulating blood and inflammatory sites after thoracic surgical stress.
Design: The subjects of the present study were 10 patients undergoing esophageal cancer surgery which requires thoracolaparotomic manipulation. The postoperative levels of interleukin (IL)-8, IL-10, IL-1 receptor antagonist (IL-1ra) and soluble tumor necrosis factor receptor I (sTNF-RI) in bronchoalveolar lavage fluids (BALFs) and peripheral blood were measured by enzyme-linked immunosorbent assay. The absolute concentration of cytokines in lower respiratory tract ([cytokine](LRT)) was estimated by using the ratio of urea concentration in BALF and serum.
Results: The levels of these cytokines in peripheral blood peaked within 24 h of start of the surgery (IL-8 85.6 +/- 29.8 pg/ml; IL-10 65.1 +/- 10.6 pg/ml; IL-1ra 2,807.8 +/- 652.8 pg/ml, and sTNF-RI 3,996.3 +/- 380.1 pg/ml). The level of [IL-8](LRT) immediately after surgery was approximately 20 times higher than that in peripheral blood, and the level of [IL-1ra](LRT) was approximately 4 times higher. In contrast, the level of [IL-10](LRT) immediately after surgery was comparable to that in peripheral blood, but the level of [sTNF RI](LRT) immediately after surgery was approximately one fifth of that in peripheral blood.
Conclusions: The balance between pro- and anti-inflammatory reactions varies from one part of the body to the next, and changes over time after surgery. The profile of stress-induced pro-inflammatory cytokines and anti-inflammatory cytokines should be analyzed further to establish appropriate and effective cytokine modulatory therapeutic approaches.
Copyright 2001 S. Karger AG, Basel