Intraperitoneal cytokine response after major surgery: higher postoperative intraperitoneal versus systemic cytokine levels suggest the gastrointestinal tract as the major source of the postoperative inflammatory reaction.
BACKGROUND
Cytokine response is an important factor in the development of shock and organ failure. The aim of this study was to investigate intraperitoneal (peritoneal) and venous (systemic) postoperative cytokine release after major surgery.


METHODS
Major abdominal surgery was performed in 19 patients. Preoperative systemic measurements and postoperative systemic and peritoneal measurements of C-reactive protein (CRP) and the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL-6), and IL-10 were performed.


RESULTS
Significantly higher TNF-alpha, IL-6, and IL-10 peritoneal values were recorded compared with systemic values, whereas peritoneal CRP was significantly decreased. CRP increased significantly over time, whereas postoperative values of IL-6, IL-10, and peritoneal TNF-alpha decreased. Systemic TNF-alpha was constant over time, but values after emergent abdominal surgery showed a more extensive response. An additional effect of surgery and emergent abdominal disease was seen in increased TNF-alpha and IL-10 levels.


CONCLUSIONS
Compared with systemic cytokines, peritoneal cytokines respond extensively after major surgery, indicating that measurement of peritoneal cytokines is a more sensible method to determine postoperative inflammatory reaction. A normal postoperative course is characterized by decreasing levels of peritoneal cytokines.
Department of Surgery, Orebro University Hospital, S-701 85 Orebro, Sweden. kjell.jansson@orebroll.se
Kjell
K
Jansson
Britt
B
Redler
Lennart
L
Truedsson
Anders
A
Magnuson
Peter
P
Matthiessen
Magnus
M
Andersson
Lars
L
Norgren
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D016207:Cytokines / Q000032:analysis / Q000097:blood*; D004064:Digestive System / Q000378:metabolism*; D005260:Female; D005767:Gastrointestinal Diseases / Q000473:pathology / Q000601:surgery*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis; D011184:Postoperative Period; D011300:Preoperative Care; D011336:Probability; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D016207:Cytokines; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002097:C-Reactive Protein