Production of Intraperitoneal Interleukin-6 Following Open or Laparoscopic Assisted Distal Gastrectomy

Abstract

The interleukin (IL)-6 concentration in plasma or serum has been considered to represent the degree of stress resulting from surgery. However, IL-6 in peritoneal fluid has rarely been considered. The aim of this study was to assess the concentration and amount of IL-6 in peritoneal fluid as indicators of surgical stress. To obtain basic data on peritoneal release of IL-6 during gastric cancer surgery, we measured IL-6 in peritoneal drainage samples, stored for up to 72 hours postoperatively, from patients who had undergone conventional open (ODG group, n ¼ 20) and laparoscopic-assisted (LADG group, n ¼ 19) distal gastrectomy. Within 24 hours, 61 and 77% of the IL-6 was released into the peritoneal cavity in the LADG and ODG groups, respectively. In both groups, the concentration and amount of peritoneal fluid IL-6 were significantly correlated with each other (LADG group: Spearman's rank correlation test [rS] ¼ 0.48, P ¼ 0.04; ODG group: rS ¼ 0.58, P ¼ 0.01). The concentration and amount of IL-6 in peritoneal fluid was 2.8-and 3.6-fold higher in the ODG than in the LADG group, respectively (P , 0.01). With regard to the relationship between the serum C-reactive protein (CRP) peak and the concentration or amount of peritoneal fluid IL-6 released within 24 hours, only the concentration of peritoneal fluid IL-6 in the LADG group was significantly correlated (rS ¼ 0.60, P ¼ 0.01) with the serum CRP peak. Our findings suggest that the amount and concentration of IL-6 released into the peritoneal cavity for up to 24 hours after surgery can each be a reliable parameter for assessment of surgical stress. Key words: Interleukin (IL)-6 -Cytokine -Peritoneal fluid -Surgical stress -Gastric cancerLaparoscopic surgery -Gastrectomy R ecent advances in laparoscopy techniques have heralded a new era in the field of abdominal surgery, and laparoscopic approaches are now being employed for the treatment of malignant neoplasms of the stomach, colon and other organs. [1][2][3][4][5] It has been reported that levels of circulating proinflammatory cytokines such as interleukin (IL)-1 beta, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha are related to the extent and severity of surgical procedures.6-8 Interleukin 6 is a sensitive and early marker of tissue damage, and in general the greater the surgical trauma, the greater the response of Many studies have shown that the level of IL-6, as an indicator of surgical stress, is significantly lower after laparoscopic surgery than after open surgery.9-15 Most of the studies reported so far have measured and analyzed the concentration of IL-6 in plasma or serum, 9,10,[12][13][14][15][16]18 and only rarely in peritoneal fluid, 11,12,15,17,19,20 and the results have indicated significant correlations between the level of IL-6 and several clinical parameters. However, there is some concern as to whether the concentration of IL-6 in peritoneal fluid adequately reflects the degree of surgical stress. Interleukin 6 is released into the abdominal cavity in response to surgical injury. 16,20,21...

Intraoperative Peritoneal Interleukin-6 Concentration Changes in Relation to the High-Mobility Group Protein B1 and Heat Shock Protein 70 Levels in Children Undergoing Cholecystectomy

“…However, IL-6 growth during open cholecystectomy was greater compared to laparoscopic cholecystectomy (62.51-fold vs. 3.19-fold). Our results are in line with other studies indicating increased inflammatory response in open surgery in comparison to the equivalent laparoscopic one [ 19 – 22 , 36 , 37 ].…”

“…This is in line with findings of Shietroma et al [ 43 , 44 ], who observed that blood IL-6 concentration began to significantly increase as early as 1 hour from the beginning of the operation. Current results also confirmed the concept, presented by other authors [ 19 , 36 , 38 , 42 ], that IL-6 concentration is very strongly and positively correlated with the hospital stay after surgery.…”

“…On the contrary, our measurements were conducted twice: at the beginning and at the end of cholecystectomy. Kumagai et al [ 19 ] and Sammour et al [ 36 ] postulate that IL-6 is a reasonable and reliable parameter for assessment of surgical stress up to 24 hours after surgery, because during this time it is mostly released into the peritoneal cavity. Zhang et al [ 39 ] found that IL-6 is increased within 6 hours after surgery.…”

“…A few earlier findings suggest that IL-6 concentration correlates with clinical parameters including length of surgery and length of hospitalization [ 19 , 38 , 42 ]. This was also confirmed by our study, as peritoneal lavage fluid IL-6 concentration is strongly, positively correlated with the duration time of cholecystectomy.…”

Curative effect of laparoscopic surgery on acute gastric perforation

“…IL-1β and IL-2 are the inflammatory factors mediating inflammatory reaction, which have a direct effect on target tissue and cause inflammatory injury [13]. IL-6 is a multifunctional cytokine which has a regulation effect on inflammatory reaction and immune reponse, and it can also mediate the cascade amplification of inflammatory reaction [14]. IL-8 is the cytokine with an effect of neutrophils chemotaxis, which can improve the activation of neutrophile granulocyte and the release of elastinase during the process of inflammatory reaction [15].…”