Patients with postoperative infections have sticky neutrophils before operation.
Appropriate polymorphonuclear neutrophil (PMN) recruitment is essential for host defense against infection. We investigated the significance of the preoperative PMN adhesion-migration process, as assessed by the flow chamber method, on postoperative infectious complications. Thirty-one consecutive patients with gastrointestinal malignancies, 21 colorectal and 10 gastric, who were undergoing elective surgery were enrolled. PMNs, isolated preoperatively from each patient's venous blood, were perfused onto a tumor necrosis factor alpha-stimulated human umbilical vein endothelial cell (HUVEC) monolayer through the flow chamber. We evaluated the adherent PMN number, the migrated PMN number, and the stuck PMN number by directly inspecting PMN interactions with a HUVEC monolayer under continuous shear flow simulating postcapillary venules. The expression of adhesion molecules on circulating PMNs was also measured. Patients were grouped into an infectious and a noninfectious group according to the occurrence of postoperative infectious complications defined by the Centers for Disease Control criteria. Eleven patients developed postoperative infectious complications. Although the number of preoperative in vitro adherent PMNs in patients with postoperative infection was significantly higher than in those without postoperative infection (P = 0.01), migrated PMN number was similar in both groups. Stuck PMN number tended to be higher in the infectious group than in the noninfectious group. The migrated PMN number showed a significant positive correlation with the adherent PMN number in the noninfectious group but not in the infectious group. Preoperative CD31 expression on circulating PMNs was significantly lower in the infectious group than in the noninfectious group. Preoperative in vitro derangement of the PMN adhesion-migration process is closely associated with postoperative infectious complications.
Hidemura
Akio
A
Department of Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Saito
Hideaki
H
Fukatsu
Kazuhiko
K
Ikeda
Shigeo
S
Kitayama
Joji
J
Matsuda
Takeaki
T
Nagawa
Hirokazu
H
D000368:Aged; D002448:Cell Adhesion / Q000502:physiology; D002460:Cell Line; D003082:Colectomy; D004730:Endothelium, Vascular / Q000166:cytology; D005260:Female; D005743:Gastrectomy; D006801:Humans; D015994:Incidence; D007239:Infections / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000601:surgery; D009504:Neutrophils / Q000473:pathology / Q000502:physiology*; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology; D011300:Preoperative Care; D012007:Rectum / Q000601:surgery; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000097:blood* / Q000453:epidemiology; D014471:Umbilical Veins