LEVELS OF PORTAL AND SYSTEMIC BLOOD CYTOKINES AFTER COLECTOMY IN PATIENTS WITH CARCINOMA OR CROHNS-DISEASE

BACKGROUND: Cytokine overproduction has been observed in different pat hophysiologic conditions, including sepsis, carcinoma, inflammatory di sease, and tissue injury induced by operation. Colectomy is a procedur e that may result in excessive cytokine release through the portal vei n. The respective effects of an operative procedure, perioperative sep tic complications, and of the disease itself on cytokine production ar e still not known. STUDY DESIGN: This study was done to investigate th e variations in the levels of interleukin-1 beta (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protei n (CRP) in portal and systemic blood during and after colectomy in pat ients with malignancy or with Crohn's disease. Blood samples were coll ected intraoperatively from portal and systemic veins of 24 patients u ndergoing colectomy for either Crohn's disease (n=13) or carcinoma (n= 11), and postoperatively (from days 1 to 5) from systemic veins. The c hanges in blood levels of cytokines and CRP in patients with an uneven tful colectomy (n=19) were compared to changes in patients whose colec tomy was complicated by sepsis (n=5). Similar changes in cytokines and CRP levels were compared between patients with malignancy and those w ith Crohn's disease. RESULTS: The portal and systemic blood levels of IL-1, IL-6, TNF-alpha, and CRP were significantly correlated before an d after colectomy. In portal blood, the level of IL-6 was significantl y higher after colectomy than before. In systemic blood, the levels of CRP, TNF-alpha, and IL-6 before colectomy were significantly higher i n patients with Crohn's disease than in patients with malignancy. Afte r uneventful colectomy, a temporary increase in CRP, TNF-alpha, and IL -6 was noted in systemic blood, followed by a rapid decrease, although systemic blood cytokine levels remained significantly higher after co lectomy complicated by sepsis. Interleukin-1 beta levels in both porta l and systemic blood remained unchanged during and after colectomy, re gardless of the indication for operation and its outcome. CONCLUSIONS: Colectomy causes acute release of cytokines and CRP in both the porta l and systemic circulation. The increase in IL-6 observed after colect omy in portal blood and subsequently in systemic blood suggests local production from the resected specimen, or at least from the area of re section. Cytokine production, especially of IL-6, was modified not onl y by the underlying disease itself, as higher levels were observed in Crohn's disease before colectomy, but also by the presence of perioper ative septic complications.