Peritoneal cytokine release after elective gastrointestinal surgery and postoperative complications

BACKGROUND: Laparotomy is known to give rise to systemic and local cytokine release. In the present study we investigated the course of the peritoneal response of tumor necrosis factor alpha (TNFalpha), interleukin (IL)-6, and IL-10 after elective gastrointestinal surgery and studied the differences in local cytokine response in patients developing postoperative complications. METHODS: Twelve consecutive patients underwent pancreatoduodenectomy (n = 9) or biliary and gastric bypass (n = 3) for pancreatic carcinoma. Sampling (TNFalpha, IL-6, IL-10) of fluid from abdominal drains was performed at return to the recovery unit (T=0), and at 3, 6, 18, 30, 42, 54, 66, 78 hours. Systemic sampling was performed at T=0, 3, 6, 18, 42, 66 hours. Postoperative cytokine response in patients with and without postoperative complications was compared. RESULTS: In patients without postoperative complications, peritoneal TNFalpha and IL-10 levels decreased in time (P = 0.07 and P = 0.01, respectively), whereas IL-6 did not change significantly during sampling (P = 0.28). Systemic IL-6 and IL-10 levels decreased 10-fold within 66 hours (IL-6, P = 0.04; IL-10, P = 0.06). Four patients experienced postoperative complications. All 4 patients with complications showed a second rise in peritoneal TNFalpha levels preceding the complication. All 4 patients had positive bacterial drain cultures from the abdominal drain, following the TNFalpha rise. CONCLUSIONS: After elective abdominal surgery, cytokines are released into the abdominal cavity. Intra-abdominal complications are accompanied or preceded by a peritoneal TNFalpha rise. In patients after elective gastrointestinal surgery, monitoring of peritoneal TNFalpha might be helpful in the early detection of severe intra-abdominal complication