Systemic cytokine response after emergency and elective surgery for colorectal carcinoma.
BACKGROUND
Systemic cytokines (SC) are accepted mediators of host immune response. It is debated if long-term survival is influenced by emergency presentation of colorectal cancer, and the role of immunitary response is still unknown. The aim of this prospective study was to compare the SC response after emergency resection with that after elective resections of colorectal carcinoma.


METHODS
One hundred six consecutive subjects with colorectal cancer were submitted to emergency (complete bowel obstruction; EMS, n = 50) or elective resection (ELS, n = 56) of the tumour. Sera were collected before surgery and at appropriate time points afterward and assayed for interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C-reactive protein (CRP). Five-year survival was analysed according to Kaplan-Meier test. The Cox proportional hazard model was used for the multivariate analysis.


RESULTS
Pre-operative levels of IL-1beta, IL-6 and CRP were statistically higher in the EMS group. Levels of TNF-alpha were not elevated after surgery and there was no difference between the groups. Five-year survival was significantly lower in the EMS group (p < 0.05).


CONCLUSIONS
Immunitary response, as reflected by SC, was better after elective resection than after emergency resection of colorectal carcinoma and this difference may have implication in the long-term survival.
Catena
Fausto
F
Transplant, General and Emergency Surgery Department, St Orsola-Malpighi University Hospital, Bologna, Italy. fcatena@aosp.bo.it
Ansaloni
Luca
L
Avanzolini
Andrea
A
Di Saverio
Salomone
S
D'Alessandro
Luigi
L
Maldini Casadei
Mario
M
Pinna
Antonio
A
D000368:Aged; D002423:Cause of Death; D015179:Colorectal Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016207:Cytokines / Q000097:blood*; D003710:Demography; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010351:Patient Discharge; D016019:Survival Analysis; D016896:Treatment Outcome
D016207:Cytokines