Hepatic resection induces a shift in the Th 1/2 balance toward Th 2 and produces hypermetabolic and hyperhemodynamic states.
OBJECTIVE
Recent studies have shown that the type 1/2 T-helper (Th 1/2) cell balance is shifted toward a Th 2-type immune response not only by malignancy but also by surgical stress. The present study evaluated surgical stress as a result of liver surgery in comparison with that of other major abdominal surgeries. Immune, metabolic and circulatory responses to surgery were measured for determination of surgical stress.


METHODS
Eighty-five patients who underwent abdominal surgeries were divided into three groups: hepatic resection (n=17), gastric resection (n=38), colorectal resection (n= 30). Blood sampling was performed before surgery, and on postoperative days (POD) 2 and 14. The Th 1/2 helper T cell balance was determined by flow cytometric analysis of interferon-gamma and interleukin-4 expression. Energy expenditure was measured by indirect calorimetry, and hemodynamics was studied using pulse dye densitometry until POD 14.


RESULTS
Following surgery Th 1/2 ratios decreased significantly. Additionally, the Th 1/2 balance in patients with hepatic resection on POD 2 was significantly lower than that of patients with other major surgeries. However, on POD 14 there were no significant differences among the three groups. Resting energy expenditure and cardiac index on postoperative days 1 and 3 in patients with hepatic resection increased significantly above levels in the other surgical groups. Conversely, blood volume in the hepatic resection patients was significantly lower than that of other patients until POD 3. Ten patients who developed postoperative complications had significantly lower Th 1/2 ratios and more hypermetabolism.


CONCLUSIONS
This study reveals that hepatic resection induces a more marked shift toward a Th 2 helper T cell response and significantly more hypermetabolism than other major surgeries. A distinct pattern of Th 1/2 ratio changes during the early phase of the postoperative course in hepatic resection may be related to changes in metabolism and circulation. Therefore, determination of Th 1/2 balance may be of help in evaluating different surgical procedures, and management of energy intake and circulatory management may be cautiously determined based on the shift in Th 1/2 balance.
Ishikawa
M
M
Department of Surgery, National Kochi Hospital, Japan. masashi@kochi.hosp.go.jp
Nishioka
M
M
Hanaki
N
N
Miyauchi
T
T
Kashiwagi
Y
Y
Miki
H
H
D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D006528:Carcinoma, Hepatocellular / Q000276:immunology / Q000601:surgery*; D004734:Energy Metabolism / Q000276:immunology*; D005260:Female; D005434:Flow Cytometry; D005770:Gastrointestinal Neoplasms / Q000276:immunology / Q000601:surgery; D006439:Hemodynamics / Q000276:immunology*; D006498:Hepatectomy; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D008113:Liver Neoplasms / Q000276:immunology / Q000556:secondary / Q000601:surgery*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology*; D013312:Stress, Physiological / Q000150:complications* / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology*; D018418:Th2 Cells / Q000276:immunology*
D015847:Interleukin-4; D007371:Interferon-gamma