The Change of Cytokines and Adhesion Molecules after Thoracic Surgery, and the Effect of Gabexate Mesylate（FOY）on this Change and the Clinical Implication
Date Issued
2000-07-31
Date
2000-07-31
Author(s)
李俊仁
DOI
892314B002188
Abstract
Background: In thoracic surgery, esophagectomy combined with esophageal reconstruction
has much higher postoperative morbidity and mortality than that of pulmonary lobectomy.
IL-6 and IL-8 are important mediators, induced in response to a major trauma or surgery, and
closely related to posttraumatic morbidity and mortality. ICAM-1 is the key regulator for the
PMN associated cytotoxicity which is the common detrimental pathway for multiple organ
failure (MOF). This study was conducted under the hypothesis that, compared to pulmonary
lobectomy, esophgectomy combined with esophageal reconstruction surgery can induce
more prominent local and systemic IL6, IL8 and ICAM-1 responses, which reflect the
intensity of surgical trauma in thoracic surgery. Methods: The level of interleukin-6 (IL-6),
interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) in the plasma
and pleural drainage were serially examined in 6 patients receiving esophagectomy combined
2
with esophageal reconstruction and 10 with pulmonary lobectomy. Results: In the first
postoperative day, patients receiving esophagectomy had significantly higher level of
circulating IL6 than those with pulmonary lobectomy (782+391 vs 88+31[pg./ml], p<0.05) .
The change of circulating IL8 was comparable between these two groups. The circulating
sICAM-1 was significantly higher in esophagectomy group since the postoperative day 5, and
the difference between the two groups expanded gradually with time. (774+89 vs 464+95,
845+82 vs 392+68[ng/ml], p<0.05 for postoperative days 5, and 7 respectively) The
concentration of IL6 and IL8 in pleural drainage was 50 to 100 times higher than that in
plasma. In contrast, the sICAM-1 level in plasma was similar to that of pleural drainage.
In the postoperative days 3 and 5 the sICAM-1 level in pleural drainage was significantly
correlated with that in plasma.( day 3: p=0.019, R=0.57; day 5: p=0.049, R=0.51) Conclusion:
Esophgectomy with esophageal reconstruction surgery, compared to pulmonary lobectomy,
can induce a more intensive systemic IL6 response in the early postoperative period and
followed by a more obvious elevation of circulating sICAM-1 in the later period. This
implies delay endothelial activation following transient cytokine stimulation after extensive
surgical trauma by esophgectomy and the vulnerability to remote organ damage in the patients
receiving esophgectomy.
Subjects
IL-6
Esophagectomy
Pulmonary Lobectomy
Publisher
臺北市：國立臺灣大學醫學院外科
Type
report
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