Deficiency in systemic interleukin-1 receptor antagonist production as an operative risk factor in malnourished elderly patients with colorectal carcinoma.
OBJECTIVE
Aging and tumor-related malnutrition are associated with increased inflammatory cytokine levels. However, it is unclear whether this influences the outcomes of surgery. We explored the relationships between cytokines and surgical complications among patients undergoing surgery for colorectal cancer.


METHODS
Laboratory experiment.


METHODS
Surgery department of school of medicine.


METHODS
One hundred patients with colorectal cancer.


METHODS
The perioperative circulating levels of interleukin (IL)-1beta, IL-6, and IL-1 receptor antagonist (Ra) were determined, and the numbers of circulating lymphocytes and neutrophils were counted.


RESULTS
Trends toward increasing postoperative infection were observed among patients who were older and had lower body mass index. Preoperative IL-1Ra and intraoperative blood loss, however, remained the only two independent predictors of postoperative infection. Clinically, patients with low preoperative IL-1Ra most frequently were the elderly with low body mass index. Postoperatively, elderly patients with low body mass index showed an exaggerated IL-6 response, followed by an exaggerated postoperative inflammatory response and increased postoperative loss of body weight. In contrast, normal immunoreactivity was preserved in well-nourished elderly patients.


CONCLUSIONS
In colorectal cancer patients undergoing surgery, low preoperative IL-1Ra is associated with postoperative infection. In our patient population, lower IL-1Ra level is commonly observed in the elderly with low body mass index. These findings suggest that postoperative infection, frequently seen in the nutritionally deficient elderly, may be the result of defective immunoinflammatory adaptation system.
Miki
Chikao
C
Second Department of Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
Inoue
Yasuhiro
Y
Toiyama
Yuji
Y
Ojima
Eiki
E
Kobayashi
Minako
M
Hatada
Tsuyoshi
T
Araki
Toshimitsu
T
Kusunoki
Masato
M
D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery; D015179:Colorectal Neoplasms / Q000276:immunology*; D005260:Female; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D053590:Interleukin 1 Receptor Antagonist Protein; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology; D011183:Postoperative Complications / Q000276:immunology*; D011237:Predictive Value of Tests; D011502:Protein-Energy Malnutrition / Q000276:immunology*; D019947:Receptors, Interleukin-6 / Q000097:blood; D012307:Risk Factors; D012795:Sialoglycoproteins / Q000172:deficiency*; D013530:Surgical Wound Infection / Q000276:immunology; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology
C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D019947:Receptors, Interleukin-6; D012795:Sialoglycoproteins