Increased monocyte activation in elderly patients after surgical stress

Objective: To investigate age-related changes in the host response to surgi cal stress. The clinical course, serum interleukin-6 (IL-6) levels, monocyt e production of tumor necrosis factor-alpha (TNF-alpha), and monocyte expre ssion of CD11b/CD18 were used as markers of the systemic response. Methods: Patients with gastric cancer, undergoing distal gastrectomy were divided i nto 2 groups: >75 years of age (elderly group) and less than or equal to 75 years of age (young group). Serum IL-6 levels, TNF-a production and CD11b/ CD18 expression by monocytes, and the postoperative clinical course were co mpared between the 2 groups. Results: TNF-alpha production by lipopolysacch aride-stimulated monocytes and CD11b/CD18 expression on monocytes after sur gical stress were significantly higher in the elderly than in the young gro up. Moreover, serum IL-6 levels on the first postoperative day in the elder ly group were significantly higher than those in the young group. The incid ence and duration of systemic inflammatory response syndrome (SIRS) were si gnificantly greater in the elderly than in the young group. Conclusions: Th e activation of monocytes and hypercytokinemia occur readily after surgical stress in the elderly and may therefore contribute to SIRS and increased s usceptibility to postoperative complications. Copyright (C) 2001 S. Karger AG, Basel.