Interleukin-6 Production in Lung Tissue After Transthoracic Esophagectomy

Systematic mediastinal lymphadenectomy does not increase postoperative immune response after major lung resections☆

“…In pleural fluid on postoperative day 1, the level of IL-1ra was significantly higher in group 3 than in group 1 (76,666 pg/ml (range 53,618-89,618) vs 16,560 pg/ml (range 15,840-18,333); p = 0.0004). The difference between group 2 and 1 was not significant (35,026 pg/ml (16,740-50,515) vs 16,560 pg/ml (15,333); p = 0.09) (Fig. 2).…”

“…(2) excised lymph nodes or removed lymphatic vessels can be the source of cytokines in pleural fluid; (3) higher number of mediastinal lymph nodes are found in the resected specimen of patients with more advanced cancer which causes more pronounced immunosuppression; (4) at least some cytokines are produced by pneumocytes in the operated lung [15], therefore concentration of cytokines is lower when the route of lymphatic drainage is transsected or removed; (5) lymphadenectomy decreases the number of mediastinal dendritic cells which play a major role in presenting inhaled bacterial antigens to T cells [16].…”

Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia

“…Thus, studies could show a pulmonary production of proinflammatory cytokines during OLV [46,47], which was more pronounced in the ventilated than in the operated lung [48 •• , 49]. This local inflammation in thoracic surgery was associated with a high incidence of postoperative pulmonary complications [50].…”

Case Scenario: Management of Postesophagectomy Respiratory Failure with Noninvasive Ventilation

“…8 In parallel, and as regularly reported following both thoracic and abdominal surgery, a pulmonary inflammatory response can impair the lung parenchyma, rendering them more sensitive to further aggressions. 5,22 Unfortunately, after esophagectomy, the inflammatory response is not limited to the lung. Indeed, the physiologic insult resulting from esophagectomy is perhaps one of the most apparent because this surgery involves multiple surgical fields.…”

“…The operative trauma is known to activate several immune cells, which results in the production of proinflammatory cytokines and promotes the development of a systemic inflammatory response. 22 Moreover, initiation of a systemic inflammatory response has previously been correlated with the further development of postoperative complications and the onset of organ dysfunction. 23,24 All of these mechanisms occurring simultaneously probably negatively influence each other, thus resulting in a "vicious circle."…”