The influence of surgical operations on components of the human immune system

Abstract

Surgical operations have been shown to cause a variety of immunological disturbances in man both in vivo and in vitro. With few exceptions the overall picture is one of a generalized state of immunodepression in the postoperative period. The implications of these observations are that host defences may be compromised by surgical procedures, thus providing a 'fertile soil' for bacterial invasion and tumour cell metastasis at the very time when risks from invading pathogens and viable tumour cells are maximal. We have studied the effects of surgical operations on the immune system in 35 patients with benign disease. Surgical procedures were classified as either minor (n = 15) or major (n = 20). A panel of monoclonal antibodies was used to identify peripheral blood lymphocyte subpopulations and analysis was performed using flow cytometry. Simultaneous estimations of plasma alpha-1 proteinase inhibitor (alpha-1-PI), alpha-2-macroglobulin (alpha-2-M), alpha-2-pregnancy-associated glycoprotein (alpha-2-PAG) and plasma suppressive activity (PSA) on stimulated allogeneic lymphocytes were performed before operation and on postoperative days 1, 3, 7, 17 and 21. Circulating numbers of all lymphocyte subpopulations fell significantly following surgery, except for B lymphocytes which did not change. The magnitude, and duration of the reduction in cell numbers and the subpopulation affected was significantly related to the degree of surgical trauma, and returned to pre-operative values by postoperative day 7. Changes in alpha-1-PI, alpha-2-M, alpha-2-PAG and PSA were also significantly related to the degree of surgical trauma, and these plasma changes persisted longer than the cellular disturbances. Surgical operations induce a reversible depression of cellular immunity which precedes plasma suppressive activity in its return to pre-operative levels. Immunostimulating agents such as interferon and the interleukins deserve evaluation as prophylactic agents pre-operatively.

Effects of Surgical Stress on Early Nonspecific Immune Response in Children

“…The current knowledge obtained by studies on adult patients is complex, confusing, and not clearly defined. Surgery is believed to be an immunodepressant, at least transiently [1][2][3]. There are however reports contradictory to this, suggesting at least some parts of the immune response may be unchanged [4,5] or enhanced [6].…”

“…Transient postoperative cellular and humoral immunosuppression after different degrees of operative stress has been reported [1][2][3].…”

Induction of tumour cell shedding into effluent venous blood breast cancer surgery

“…Studies of the 'no-touch' surgical technique failed to show any survival benefit, but had ample scope for a type II statistical error (failing to detect a real difference due to lack of power). Surgery suppresses cellular immune function and induces expression of growth factors that may stimulate cell division in micrometastases (Lennard et al, 1985;Fisher et al, 1989;Herlyn et al, 1990;McCarthy et al, 1991 …”

Immunologic Consequences and Considerations of the Laparoscopic Approach

“…Interactions between cells, chemotaxis, expression of surface antigens, the ability to produce cytokines, and other functions of these immune system cells are negatively influenced by open surgical trauma. Further, the ability to mount a positive response to a delayed-type hypersensitivity (DTH) recall antigen challenge is suppressed after surgery [1][2][3][4][5].The relative contribution of each part of an abdominal procedure (abdominal wall access incision versus intraabdominal dissection and resection) to postsurgical immunosuppression had not been assessed before the advent of advanced laparoscopic methods. The results of recent studies suggest that the method of entry into the abdomen is the most important determinant of postoperative immune function.…”

“…Interactions between cells, chemotaxis, expression of surface antigens, the ability to produce cytokines, and other functions of these immune system cells are negatively influenced by open surgical trauma. Further, the ability to mount a positive response to a delayed-type hypersensitivity (DTH) recall antigen challenge is suppressed after surgery [1][2][3][4][5].…”