Cytokine Response in the Pleural Fluid and Blood in Minimally Invasive and Open Esophagectomy

Abstract

Background Transthoracic esophagectomy for cancer triggers a massive inflammatory reaction. The data whether a minimally invasive esophagectomy (MIE) leads to less pronounced inflammatory response compared to open rightsided transthoracic esophagectomy (OE) are scarce. The aim of this study was to evaluate the extent of the inflammatory reaction, represented by levels of the pro-inflammatory interleukins IL-6 and IL-8, the anti-inflammatory IL-1 RA and the chemokines CINC-1 and MCP-1 in the right pleural fluid and the blood from patients undergoing standard OE or MIE. Methods Pleural drainage fluid and blood was collected at five different time points during the first 72 h following surgery, and the concentrations of IL-6, IL-8, IL-1 RA, CINC-1 and MCP-1 were analyzed using enzyme-linked immune-sorbent assays in 24 patients undergoing MIE or OE. Results The groups were matched for cancer stage and comorbidities. Pro-and anti-inflammatory mediator levels in the pleural fluid were markedly increased at the end of surgery and on postoperative days 1-3. The pleural inflammatory response of all cyto-and chemokines was lower in the MIE group, reaching significance at some time points. Cyto-and chemokine response levels measured in the blood were overall lower compared to those in the pleural fluid. The chemokines CINC-1 and MCP-1 reacted less pronounced or not at all. Preoperative pulmonary comorbidity, postoperative pulmonary morbidity and length of surgery were associated with an increased reaction in selected mediators. Conclusions The minimally invasive technique attenuates the inflammatory response, especially locally in the thoracic compartment. Length of procedure, preoperative pulmonary comorbidity and postoperative pulmonary complications are mirrored in an increase in individual inflammatory markers in the pleural fluid. The value of the chemokines CINC-1 and MCP-1 as markers of inflammation in the setting of esophagectomy is unclear.

Impact of Prophylactic Corticosteroid Use on In-hospital Mortality and Respiratory Failure After Esophagectomy for Esophageal Cancer

“…The associations between prophylactic corticosteroids and lower in-hospital mortality, respiratory failure, and severe respiratory failure were consistent in all subgroups. Notably, the association between prophylactic corticosteroids and reduced respiratory failure was also observed in patients with MIE, which is less invasive and attenuates systemic inflammatory response compared with open esophagectomy 35. Moreover, the outcomes were favorable in the corticosteroid group regardless of hospital preference for early extubation.…”

“…Notably, the association between prophylactic corticosteroids and reduced respiratory failure was also observed in patients with MIE, which is less invasive and attenuates systemic inflammatory response compared with open esophagectomy. 35 Moreover, the outcomes were favorable in the corticosteroid group regardless of hospital preference for early extubation. These results suggest that prophylactic corticosteroids may be beneficial even in patients who undergo MIE in hospitals where early extubation, a key component of enhanced recovery after surgery, 12,13,36,37 is achieved.…”

Impact of Minimally Invasive Esophagectomy in Post-Operative Atrial Fibrillation and Long-Term Mortality in Patients Among Esophageal Cancer

“…This indicated that minimally invasive techniques attenuate the inflammatory response compared to open surgery. 18 Lower C-reactive protein levels and white cell blood counts were associated with minimally invasive esophagectomy, suggesting an improved state of systemic inflammatory and catabolic responses to surgical trauma. 19 The trauma and associated inflammatory reactions play a major role in the pathogenesis of POAF.…”