Systemic and pulmonary responses of inflammatory cytokines following esophagectomy.

Inflammatory cytokines in plasma and bronchoalveolar lavage fluid (BALF) from 16 post-esophagectomy patients with and without preoperative methylprednisolone administration were studied. Interleukin-8 (IL-8), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) concentrations in plasma and BALF were measured by ELISA immediately after surgery (0-POD) and on the postoperative day 1 (1-POD). In patients without methylprednisolone treatment, IL-8 levels in BALF were 362 +/- 67 pg/ml on 0-POD and 948 +/- 359 pg/ml on 1-POD, and were approximately 10 times higher than those in plasma levels. IL-6 levels in plasma were significantly higher than those in BALF. The TNF-alpha concentration was similarly low in plasma and BALF. The patients with preoperative methylprednisolone treatment had significantly lower IL-8 levels in BALF and plasma compared with the patients without the treatment. Immunocytochemically, each cytokine was identified in the cytoplasm of bronchoalveolar macrophage. The percentage of polymorphonuclear cells (PMN) among BAL cells was significantly increased on 1-POD when compared with that of 0-POD, and tended to be decreased by preoperative methylprednisolone treatment. These results suggest that IL-6 was markedly increased in the peripheral circulation and that increased pulmonary IL-8 might be related to an accumulation of PMN in the lung under surgical stress. Further, methylprednisolone administration could possibly reduce postoperative cytokine responses at the local and systemic levels.