Inflammation and pro-resolution inflammation after hepatobiliary surgery

Abstract

BackgroundThe magnitude of the perioperative inflammatory response plays a role in surgical outcomes. However, few studies have explored the mechanisms of the resolution of inflammation in the context of surgery. Here, we described the temporal kinetics of interleukin-6, cortisol, lipoxin A4, and resolvin D in patients who underwent oncologic liver resections.MethodsAll patients gave written informed consent. Demographic and perioperative surgical data were collected, along with blood samples, before surgery and on the mornings of postoperative days 1, 3, and 5. Interleukin-6, cortisol, lipoxin-A4, and resolvin D were measured in plasma. A P value < 0.05 was considered statistically significant.ResultsForty-one patients were included in the study. Liver resection for colorectal metastatic disease was the most commonly performed surgery. The plasma concentrations of interleukin-6 were highest on day 1 after surgery and remained higher than the baseline up to postoperative day 1. Postoperative complications occurred in 14 (24%) patients. Cortisol concentrations spiked on postoperative day 1. The concentrations of lipoxin A4 and resolvin D were lowest on day 1 after surgery.ConclusionsThe inflammatory response associated with hepatobiliary surgery is associated with low circulating concentrations of lipoxin A4 and resolvin D that mirror, in an opposite manner, the kinetics of interleukin 6 and cortisol.Trial registration NCT01438476

Sodium homeostasis in the tumour microenvironment

“…For example, regional anaesthesia reduces the need for general anaesthetic drugs and opioids, which have various deleterious effects on immunity (223). The local anaesthetic lidocaine stimulates natural killer cell cytolytic activity (224) and several local anaesthetics inhibit src activity independently of VGSC blockade (225). As well as inhibiting VGSCs, valproic acid acts as a histone deacetylase inhibitor, and this action is commonly considered responsible for its anti-cancer properties (226).…”

Potential impact of invasive surgical procedures on primary tumor growth and metastasis

“…An alternative approach is to utilize factors that would resolve the acute inflammation that is triggered by surgical procedures [ 152 ]. Perioperative treatment with dexamethasone, a potent anti-inflammatory drug, has shown to prevent biopsy-induced tumor cell migration and proliferation by reducing monocytes recruitment to the injured site and reduced growth of biopsied tumors in multifocal glioblastoma patients [ 4 ].…”

Preoperative stimulation of resolution and inflammation blockade eradicates micrometastases

“…Cancer treatment is a double-edged sword, as surgery (including biopsy), chemotherapy, or radiation can induce tumor-dormancy escape and subsequent metastatic outgrowth by impairing tumor-specific immunity through inflammation-mediated growth signals and loss of resolution of inflammation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Even anesthetics can impair inflammation resolution (17).…”