Immunomodulating Effects of Surgical Intervention in Tumors of the Head and Neck

Abstract

The immunomodulating effect of primary surgical intervention in 33 patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx was analyzed prospectively. An operation time of longer than 7 hours was significantly associated with a decrease of total lymphocyte counts, CD4(+) T lymphocytes, and CD8(+) T lymphocytes. The CD4/CD8 ratio as a marker for the downregulation of the cellular immune response was slightly decreased but still in the normal range. CD4(+) lymphocyte counts increased within 7 days, and CD8(+) lymphocytes increased 4 weeks after the operation. The in vitro stimulation of the lymphocytes was impaired for 1 to 4 weeks. Release of interleukins, interferon-gamma, and tumor necrosis factor-alpha remained low despite the surgical trauma. The decreased lymphocyte counts, especially CD4(+) and CD8(+) lymphocytes, were significantly associated with duration of operation and volume of blood loss. Extension of trauma, age, type of anesthesia, and type of intensive care intervention were not associated with specific immunomodulating effects. However, these factors might be responsible for suppression of the immune system, which is expressed by lymphocyte depletion, lymphocyte dysfunction, and impaired upregulation of cytokine secretion.

Perioperative Period: Immunological Modifications

“…However, after septic complications, a prevalent reduction ofCD4+ counts may be observed (37,38). These alterations correlate well with the reported up-regulation in pro-apoptotic mechanisms in mononuclear cells after surgical trauma, mediated by Fas, FasL and the caspase signaling patways, leading to lymphocytopenia (39).…”

Surgical trauma: hyperinflammation versus immunosuppression?

“…This lymphocyte depression has been shown to correlate with the duration of the surgical procedure, and the volume of blood loss, however, was not associated with the extension of the trauma, the age of the patient, or the type of intensive care intervention [58]. Deactivation of the cell system was further confirmed by the fact that after in vitro stimulation of those lymphocytes, the release of interleukins, IFN-g and TNF-a remained low [58]. The cause of the fall in lymphocyte count due to surgical trauma may involve a dysregulated expression of apoptotic death and survival factors.…”

“…In fact, major surgical interventions are associated with a significant decrease in total systemic lymphocyte counts, including both CD4(+) and CD8(+) cells [58]. This lymphocyte depression has been shown to correlate with the duration of the surgical procedure, and the volume of blood loss, however, was not associated with the extension of the trauma, the age of the patient, or the type of intensive care intervention [58]. Deactivation of the cell system was further confirmed by the fact that after in vitro stimulation of those lymphocytes, the release of interleukins, IFN-g and TNF-a remained low [58].…”

Gastric Cancer Immunotherapy: An Overview

“…This lymphocyte depression has been shown to correlate with the duration of the surgical procedure, and the volume of blood loss, however, was not associated with the extension of the trauma, the age of the patient, or the type of intensive care intervention [114]. The cause of the fall in lymphocyte count due to surgical trauma may involve a dysregulated expression of apoptotic death and survival factors.…”

“…+ cells [114]. This lymphocyte depression has been shown to correlate with the duration of the surgical procedure, and the volume of blood loss, however, was not associated with the extension of the trauma, the age of the patient, or the type of intensive care intervention [114].…”