Cytokine Response in the Pleural Fluid and Blood in Minimally Invasive and Open Esophagectomy
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Transthoracic esophagectomy for cancer triggers a massive inflammatory reaction. The data whether a minimally invasive esophagectomy (MIE) leads to less pronounced inflammatory response compared to open right-sided transthoracic esophagectomy (OE) are scarce. The aim of this study was to evaluate the extent of the inflammatory reaction, represented by levels of the pro-inflammatory interleukins IL-6 and IL-8, the anti-inflammatory IL-1 RA and the chemokines CINC-1 and MCP-1 in the right pleural fluid and the blood from patients undergoing standard OE or MIE.
Pleural drainage fluid and blood was collected at five different time points during the first 72 h following surgery, and the concentrations of IL-6, IL-8, IL-1 RA, CINC-1 and MCP-1 were analyzed using enzyme-linked immune-sorbent assays in 24 patients undergoing MIE or OE.
The groups were matched for cancer stage and comorbidities. Pro- and anti-inflammatory mediator levels in the pleural fluid were markedly increased at the end of surgery and on postoperative days 1–3. The pleural inflammatory response of all cyto- and chemokines was lower in the MIE group, reaching significance at some time points. Cyto- and chemokine response levels measured in the blood were overall lower compared to those in the pleural fluid. The chemokines CINC-1 and MCP-1 reacted less pronounced or not at all. Preoperative pulmonary comorbidity, postoperative pulmonary morbidity and length of surgery were associated with an increased reaction in selected mediators.
The minimally invasive technique attenuates the inflammatory response, especially locally in the thoracic compartment. Length of procedure, preoperative pulmonary comorbidity and postoperative pulmonary complications are mirrored in an increase in individual inflammatory markers in the pleural fluid. The value of the chemokines CINC-1 and MCP-1 as markers of inflammation in the setting of esophagectomy is unclear.
The authors thank all involved surgeons for their contribution and Mrs Ramona Bolognini for the analysis of the cyto- and chemokines. We thank Dr. Tracy Glass (PhD, Biostatistics and Epidemiology) for her statistical analysis review.
TD contributed to data collection, statistical analysis and drafted the manuscript. UZ contributed to the study design, sample and data collection and revision of the manuscript. DW and BBS were involved in the study design, manuscript content and its revision. AI and DJH were involved in samples and data collection, cytokine analysis, contribution to the manuscript and its revision. All authors read and gave approval to the final manuscript version.
The study was supported by a grant (09-2008) from the Freie Akademische Gesellschaft Basel, Switzerland.
Compliance with ethical standards
Conflict of interest
Drs. Delko, Watson, Beck-Schimmer, Immanuel, Hussey and Zingg have no conflicts of interest or financial ties to disclose in relation to this study.
The study has been performed in accordance with the Declaration of Helsinki. Informed consent was obtained, and the trial was approved by the Flinders Clinical Research Ethics Committee.
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