Relation between tumour necrosis factor α and interleukin 1β producing capacity of peripheral monocytes and pulmonary complications following oesophagectomy

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Abstract
Background: Adult respiratory distress syndrome and pneumonia remain a significant cause of morbidity and death following oesophagectomy. The aim of this study was to clarify the association between tumour necrosis factor (TNF) α and interleukin (IL) 1β with these pulmonary complications. Methods: The in vitro TNF-α and IL-1β producing capacity of peripheral monocytes with or without lipopolysaccaride (LPS) and serum level of IL-6 was measured in 19 patients with oesophageal cancer before and after surgery and in ten age-matched controls. Results: Six patients had raised TNF-α and IL-1β producing capacity of monocytes without LPS both before operation and on the day after surgery. In these patients plasma elastase and serum IL-6 levels subsequently increased while the ratio of arterial partial pressure of oxygen to fraction inspired oxygen decreased, and they developed bilateral lung infiltration on chest radiography on days 3–7. Five of the six developed pneumonia compared with none of the remaining 13 patients (P < 0·05). Conclusion: Pulmonary impairment and pneumonia following oesophageal surgery was associated with raised monocyte producing capacity of TNF-α and IL-1β. These markers may be valuable in the preoperative assessment of patients awaiting oesophagectomy.