Abstract
The endocrine and immune changes associated with surgery are well documented, but the interaction between them has not been fully evaluated. We, therefore, investigated the possible effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines. Thirty-five patients were enrolled in the study (26 females and 9 males, aged 42.4±16.9 yr, who were admitted to General Surgery Clinic for laparascopic cholecystectomy). Serum C-reactive protein, cortisol, thyroid stimulating hormone, free tri-iodothyronine, free thyroxine, tumor necrosis factor-α, interleukin- 1 β, soluble interleukin-2 receptor, interleukin-6, and interleukin-8 levels were evaluated 6 h before and after the operation. Postoperative cortisol (p=0.02), TSH (p=0.034), tumor necrosis factor-α (p=0.003), soluble interleukin-2 receptor (p=0.004) were found to be significantly higher than their corresponding preoperative levels. However, postoperative serum free thyroxine (p=0.011), and free tri-iodothyronine levels (p=0.001) were decreased when compared with preoperative levels, respectively. No significant difference was observed in C-reactive protein, interleukin-1 β, interleukin-6, and interleukin- 8 levels. C-rective protein levels did not change in the early period of the surgical stress. Cytokine responses observed in the early period were found to be conflicting. Cortisol is an important marker of surgical stress which also has close relationship with thyroid functions.
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Buckingham JC. Hypothalamo-pituitary response to trauma. Br Med Bull 1985, 41: 203–11.
Weissman C. The metabolic response to stress: An overview and update: Anesthesiology 1990, 73: 308–27.
Di Padova F, Pozzi C, Tondre MJ. Selective and early increase of IL-1 inhibitors, IL-6 and cortisol after elective surgery. Clin Exp Immunol 1991, 85: 137–42.
Geiger T, Andus T, Klapproth J, Hirono T, Kishimoto T, Heinrich PC. Induction of rat acute phase proteins by interleukin- 6 in vivo. Eur J Immunol 1988, 18: 717–21.
Helle M, Brakenhoff JPJ, de Groot ER, Aarden LA. Interleukin-6 is involved in interleukin-1 induced activities. Eur J Immunol 1988, 18: 957–9.
Nijsten MW, de Groot ER, ten Duis HJ, Klasen HJ, Hack CE, Aarden LA. Serum levels of interleukin-6 and acute phase response. Lancet 1987, 2: 921.
Nathan JF. Secretary products of macrophages. J Clin Invest 1987, 79: 319–26.
Fischer CL, Gill C, Forrester MG, Nakamura R. Quantitation of acute phase proteins postoperatively. Am J Clin Pathol 1976, 66: 840–6.
Marinkovic S, Jahreis GP, Wong GG, Baumann H. IL-6 modulates the synthesis of a specific set of acute phase plasma proteins in vivo. J Immunol 1989, 142: 808–12.
Kishimoto T. The biology of interleukin-6. Blood 1989, 74: 1–10.
Shenkin A, Fraser WD, Series J, et al. The serum interleukin- 6 response to elective surgery. Lymphokine Res 1989, 8: 123–7.
Sweed Y, Puri P, Reen DJ. Early induction of IL-6 in infants undergoing major abdominal surgery. J Pediatr Surg 1992, 27: 1036–7.
Wallace AM, Sattar N, Mcmillan DC. The co-ordinated cytokine/ hormone response to acute injury incorporates leptin. Cytokine 2000, 12: 1042–5.
Norman JG, Fink GW. The effects of epidural anesthesia on the neuroendocrine response to major surgical stress: a randomized prospective trial. Am Surg 1997, 63: 75–80.
Jameson P, Desborough JP, Bryant AE, Hall GM. The effect of cortisol suppression on interleukin-6 and white blood cell responses to surgery. Acta Anaesthesiol Scand 1997, 41: 304–8.
Fantuzzi G, Di Santo E, Sacco S, Benigni F, Ghezzi P. Role of the hypothalamus-pituitary-adrenal axis in the regulation of TNF-a production in mice. Effect of stress and inhibition of endogenous glucocorticoids. J Immunol 1995, 155: 3552–5.
Swain MG, Maric M. Tumor necrosis factor-alpha stimulates adrenal glucocorticoid secretion in cholestatic rats. Am J Physiol 1996, 270: G987–91.
Kato M, Suzuki H, Murakami M, Akama M, Matsukawa S, Hashimato Y. Elevated plasma levels of interleukin-6, interleukin- 8, and granulocyte colony-stimulating factor during and after major abdominal surgery. J Clin Anasth 1997, 9: 293–8.
Nishiguchi K, Okuda J, Toyoda M, Tanaka K, Tanigawa N. Comparative evaluation of surgical stress of laparoscopic and open surgeries forcolorectal carcinoma. Dis Colon Rectum 2001, 44: 223–30.
Chernow B, Alexander HR, Smallridge RC, et al. Hormonal responses to graded surgical stress. Arch Intern Med 1987, 147: 1273–8.
Kristiansson M, Saraste L, Soop M, Sundqvist KG, Thorne A. Diminished interleukin-6 and C-reactive protein responses to laparoscopic versusopen cholecystectomy. Acta Anaesthesiol Scand 1999, 43: 146–52.
Karayiannakis AJ, Makri GG, Mantzioka A, Karousos D, Karatzas G. Systemic stress response after laparoscopic or open cholecystectomy: arandomized trial. Br J Surg 1997, 84: 467–71.
Kertesz A, Godo G, Falkay G, Boros M. Plasma cortisol, prolactin and thyroxine levels related to midazolam anaesthesia. Acta Med Hung 1986, 43: 283–9.
Bozkurt P, Kaya G, Altintas F, et al. Systemic stress response during operations for acute abdominal pain performed via laparascopy or laparatomy in children. Anaesthesia 2000, 55: 5–9.
Wellby ML, Kennedy JA, Barreau PB, Roediger WE. Endocrine and cytokine changes during elective surgery. J Clin Pathol 1994, 47: 1049–51.
Rutberg H, Hakanson E, Anderberg B, Jorfeldt L, Schildt B, Tegler L. Thyroid hormones, catecholamine and cortisol concentrations after upper abdominal surgery. Acta Chir Scand 1984, 150: 273–8.
Chikenji T, Mizutani M, Kitsukawa Y. Anaesthesia, not surgical stress, induces increases in serum concentrations ofreverse triiodothyronine and thyroxine during surgery. Exp Clin Endocrinol 1990, 95: 217–23.
Kotani G, Usami M, Kasahara H, Saitoh Y. The relationship of IL-6 to hormonal mediators, fuel utilization, and systemic hypermetabolism after surgical trauma. Kobe J Med Sci 1996, 42: 187–205.
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Sari, R., Sevinc, A. The effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines. J Endocrinol Invest 27, 106–110 (2004). https://doi.org/10.1007/BF03346253
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DOI: https://doi.org/10.1007/BF03346253