Inflammatory response in ventilated left and collapsed right lungs, serum and pleural fluid, in transthoracic esophagectomy for cancer

Abstract

Introduction: Open, right-sided, transthoracic esophagectomy with one-lung ventilation (OLV) triggers a massive inflammatory reaction. The influence of the OLV on the inflammatory cascade is unclear. Data on the inflammatory response in the ventilated left and collapsed right lung, respectively, are scarce. The aim of this study was to analyze this reaction in bronchoalveolar lavage (BAL) fluid from both lungs, the right pleural space and the peripheral blood, and to study its time course.

Methods: Concentrations of interleukin (IL)-6, IL-8, IL-10 and IL-1RA in the BAL fluids from the right and left lungs, respectively, in the peripheral blood and in the right pleural space in patients undergoing transthoracic esophagectomy for cancer, were determined using enzyme-linked immunosorbent assays in 29 patients.

Results: Assay of the pro-inflammatory cytokines in the bilateral BAL fluids showed significantly higher concentrations in the ventilated left lung at the time of extubation. The anti-inflammatory response was only seen with respect to IL-1RA, but not IL-10, and was mostly restricted to the ventilated left lung. In the blood, only IL-6, IL-10 and IL-1RA increased, whereas IL-8 showed little change. The response was already observed at the end of surgery, indicating a rapid reaction to the surgical and anesthetic trauma. In the pleural fluid, all cytokine concentrations increased, and the highest values were detected on day one post-surgery, and decreased thereafter. Pulmonary complications or anastomotic leakage were not related to the cytokine concentrations.

Conclusion: Both the ventilated left and the collapsed right lung showed an inflammatory response. The response was more pronounced on the ventilated left side and the time courses were significantly different. In the blood, the pro-inflammatory IL-6 and both anti-inflammatory cytokines increased early on. All cytokines increased in the pleural cavity. The findings underline the complexity of the inflammatory reaction associated with OLV in transthoracic esophagectomy.