Serum cytokine changes after gastric resection or gastrectomy for gastric cancer.

Background/aims: Although essential for postoperative recovery, excessive surgical stress response leads to higher rate of serious postoperative complications, such as sepsis and multiple organ disorder syndrome. Exact regulation of surgical stress response is not yet known. Still, our ability to modify surgical stress response severity has led to diminished postoperative morbidity and mortality rates and development of fast-track surgery. In this study we tried to further clarify the roles of several cytokines in surgical stress response regulation.

Methodology: We measured leukocyte count and serum concentrations of C-reactive protein, IL-2, IL-6, IL-10, TNF-alpha, IFN-gamma and cortisol in patients undergoing gastrectomy or gastric resection for gastric cancer. Blood samples were collected preoperatively, 3 hours, 24 hours and 48 hours postoperatively. We also grouped our patients according to operation type and duration and then compared measured values between groups.

Results: Elevated postoperative leukocyte count and serum concentrations of IL-4, IL-6, IL-10 and cortisol were measured, all peaking at 3 hours postoperatively. Also, serum IL-6 concentration was higher after longer operations, and leukocyte count was higher after gastrectomy.

Conclusions: The synchronicity of postoperative elevation of IL-4, IL-6 and IL-10 concentrations, each having different role in surgical stress response regulation, might indicate that, in order to determine surgical stress response severity, several cytokines should be measured simultaneously.