RELATION BETWEEN TUMOR-NECROSIS-FACTOR-ALPHA AND INTERLEUKIN-1-BETA PRODUCING CAPACITY OF PERIPHERAL MONOCYTES AND PULMONARY COMPLICATIONS FOLLOWING ESOPHAGECTOMY

Background Adult respiratory distress syndrome and pneumonia remain a significant cause of morbidity and death following oesophagectomy. The aim of this study was to clarify the association between tumour necro sis factor (TNF) alpha and interleukin (IL) 1 beta with these pulmonar y complications. Methods The in vitro TNF-alpha and IL-1 beta producin g capacity of peripheral monocytes with or without lipopolysaccaride ( LPS) and serum level of IL-6 was measured in 19 patients with oesophag eal cancer before and after surgery and in ten age-matched controls. R esults Six patients had raised TNF-alpha and IL-1 beta producing capac ity of monocytes without LPS both before operation and on the day afte r surgery. In these patients plasma elastase and serum IL-6 levels sub sequently increased while the ratio of arterial partial pressure of ox ygen to fraction inspired oxygen decreased, and they developed bilater al lung infiltration on chest radiography on days 3-7. Five of the six developed pneumonia compared with none of the remaining 13 patients ( P < 0.05). Conclusion Pulmonary impairment and pneumonia following oes ophageal surgery was associated with raised monocyte producing capacit y of TNF-alpha. and IL-1 beta. These markers may be valuable in the pr eoperative assessment of patients awaiting oesophagectomy.