Increased monocyte activation in elderly patients after surgical stress.
OBJECTIVE
To investigate age-related changes in the host response to surgical stress. The clinical course, serum interleukin-6 (IL-6) levels, monocyte production of tumor necrosis factor-alpha (TNF-alpha), and monocyte expression of CD11b/CD18 were used as markers of the systemic response.


METHODS
Patients with gastric cancer, undergoing distal gastrectomy were divided into 2 groups: >75 years of age (elderly group) and < or =75 years of age (young group). Serum IL-6 levels, TNF-alpha production and CD11b/CD18 expression by monocytes, and the postoperative clinical course were compared between the 2 groups.


RESULTS
TNF-alpha production by lipopolysaccharide-stimulated monocytes and CD11b/CD18 expression on monocytes after surgical stress were significantly higher in the elderly than in the young group. Moreover, serum IL-6 levels on the first postoperative day in the elderly group were significantly higher than those in the young group. The incidence and duration of systemic inflammatory response syndrome (SIRS) were significantly greater in the elderly than in the young group.


CONCLUSIONS
The activation of monocytes and hypercytokinemia occur readily after surgical stress in the elderly and may therefore contribute to SIRS and increased susceptibility to postoperative complications.
Ono
S
S
First Department of Surgery, National Defense Medical College, Saitama, Japan. satoshi@me.ndmc.ac.jp
Aosasa
S
S
Tsujimoto
H
H
Ueno
C
C
Mochizuki
H
H
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000378:metabolism*; D001831:Body Temperature; D018821:CD18 Antigens / Q000097:blood; D005743:Gastrectomy / Q000009:adverse effects*; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D016177:Macrophage-1 Antigen / Q000097:blood; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism / Q000502:physiology*; D011183:Postoperative Complications; D011184:Postoperative Period; D012119:Respiration; D013312:Stress, Physiological / Q000097:blood* / Q000209:etiology*; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D018821:CD18 Antigens; D015850:Interleukin-6; D016177:Macrophage-1 Antigen; D014409:Tumor Necrosis Factor-alpha