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 α (TNFα), 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 (TNFα, 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 TNFα 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 TNFα levels preceding the complication. All 4 patients had positive bacterial drain cultures from the abdominal drain, following the TNFα rise. Conclusions: After elective abdominal surgery, cytokines are released into the abdominal cavity. Intra-abdominal complications are accompanied or preceded by a peritoneal TNFα rise. In patients after elective gastrointestinal surgery, monitoring of peritoneal TNFα might be helpful in the early detection of severe intra-abdominal complications.