Changes in immune function following surgery for esophageal carcinoma

Changes in immune function due to surgical injury have been well-documented . Immunosuppression is one of the causes of infectious complications leadin g to organ dysfunction in critical illness. It is not known what kind of su rgery in the daily clinical practice causes immunosuppression. Stress respo nse and immune function following surgery for esophageal carcinoma, assumin g a highly-stressed operation, were studied and then compared with the stre ss response and immune function following gastric surgery, a moderately-str essed procedure. Forty patients who underwent esophagectomy and 39 patients receiving gastric operation were studied. The concentrations of serum inte rleukin-6 (IL-6) were measured preoperatively, at 1, 2, and 6 h, and at 1, 3, and 10 d after operation. Total protein, serum albumin, rapid turnover p rotein, serum CRP, and cortisol were measured before operation and at 1, 3, 7, and 21 d after operation. ConA- and PHA-stimulated lymphocyte prolifera tion, IgA, IgG, and IgM were also measured preoperatively, and on 7 and 21 d following surgery. The patients were fed exclusively by total parenteral nutrition (TPN). A striking rise of IL-6 was observed, with a peak in both groups at 1 to 6 h following operation. The peak values were 419 +/- 30 pg/ mL, which was approximately twice as high in the esophagectomy patients as in the gastrectomy patients (195 +/- 40 pg/mL). CRP and cortisol also incre ased after operation, and these increases were also significantly greater i n the esophagectomy patients. ConA- and PHA-stimulated lymphocyte prolifera tion decreased significantly 7 d after esophagectomy (P < 0.05), but was un changed in the patients receiving gastrectomy. Suppression of cellular immu nity correlated significantly with serum cortisol, and was preceded by a ri se in serum IL-6. The IgA, IgG, and IgM levels, however, remained unchanged from their preoperative values throughout the study in both groups. Nutrit ional status in terms of serum protein, albumin, and rapid turnover protein , decreased postoperatively, but there was no difference between the two gr oups. It is, therefore, concluded that cell-mediated immunosuppression, pre ceded by a hyperinflammatory response, is an observable reaction in patient s following esophageal surgery, but not in patients undergoing gastric surg ery. Nutrition 1999;15:760-766. (C) Elsevier Science Inc. 1999.