Perioperative alterations in polymorphonuclear leukocyte function of gastrointestinal surgery.

Abstract

To characterize the alteration of perioperative polymorphonuclear leukocytes (PMNs) function in surgical stress, we studied twenty six patients undergoing gastrointestinal surgery. Seventeen patients with thoracic esophageal cancer underwent total thoracic esophagectomy through a right thoracotomy (severe surgical stress group). Nine patients underwent cholecystectomy (slight surgical stress group). Phagocytic oxygen-dependent microbicidal activity in the esophagectomy patients significantly increased postoperatively, by measuring O2- production (35.3 +/- 7.0 nmol/10(6) cells/ml/20 min on postoperative day 1 vs. 28.6 +/- 6.2 preoperatively, p < 0.01) and luminol-dependent chemiluminescence (99.5 +/- 29.9 x 10(5) cpm/10(5) cells on postoperative day 3 vs. 67.5 +/- 12.8 preoperatively, p < 0.01). On the other hand, only a slight change was seen in the cholecystectomy patients. We conclude that the postoperative PMN function in terms of oxygen-dependent microbicidal activity significantly increases when the degree of surgical stress is sufficient. In order to gain insight into the mechanism of PMN activation, we specifically analyzed the expression of complement receptors. Up-regulation of complement receptors were seen in the esophagectomy patients, which parallels the activation of PMN microbicidal activities. It was suggested that phagocytic PMN function in severe surgical stress significantly increases postoperatively, in part, based on the upregulation of cell surface complement receptors.