Early postoperative compensatory anti-in¯ammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer D.Mokart,C.Capo*,J.L.Blache,J.R.Delpero², G. Houvenaeghel²,C.Martin³ andJ.L.Mege* Intensive Care Unit and Department of Anaesthesiology, and ²Department of Surgery, Institut Paoli-Calmettes, *Haematology and Immunology Laboratory, Ho à pital la Conception and ³Intensive Care Unit, Ho à pital Nord, Marseilles, France Correspondence to: Dr D. Mokart, De Âpartement d'Anaesthe Âsie-Re Âanimation, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13 273 Marseilles Cedex 9, France e-mail: mokartd@marseille.fnclcc.fr) Background: Patientswhoundergomajorsurgeryforcancerareathighriskofpostoperativeinfection. Postoperativeimmunosuppressionmaybeduetodysregulationofcytokineproduction.Theaimofthis study was to investigate the association between changes in serum proin¯ammatory and anti- in¯ammatorycytokineconcentrationsandpostoperativesepticcomplicationsaftermajorsurgery. Methods: Serialbloodsampleswerecollectedfrom30consecutivepatientsfordeterminationofserum cytokinelevels.Healthyvolunteerswereusedasthecontrolgroup. Results: Eleven patients developed no complications group 1), 14 developed sepsis or severe sepsis group 2), and ®ve developed septic shock group 3). On day 1 the patients in groups 2 and 3 had signi®cantlyhigherlevelsofinterleukinIL)6thanthoseingroup1.IL-6levelsremainedhighuntilday 5.TumournecrosisfactorTNF),IL-1,interferonIFN) g andIL-12levelswerenotaffectedbysurgical trauma or by the occurrence of septic complications. After operation the circulating IL-1 receptor antagonist IL-1ra) concentration was increased in all groups, but patients in group 3 had signi®cantly higherlevelsofIL-1rathanthoseingroup1.IL-1ralevelscorrelatedwithIL-6levels.Thepatternof IL-10levelswassimilartothatofIL-1ralevels. Conclusion: Serum concentrations of proin¯ammatory cytokines TNF, IL-1, IFN-g and IL-12) were notaffectedbyoperationortheoccurrenceofsepticcomplications.ThepostoperativeincreaseinIL-6 concentration was associated with septic morbidity, while raised IL-1ra concentration was associated withpostoperativesepticshock. Paper accepted 13 June 2002 British Journal of Surgery 2002, 89, 1450±1456 Introduction Patients undergoing major oncological resection are at high risk of postoperative infectious complications 1 . Recent therapeutic advances, both medical and surgical, have enabled clinicians to reduce early postoperative mortality rates. Despite this progress, certain patients remain at high risk of infection and the attendant risk of increased morbidity and mortality. The immunosuppression that occurs after severe accidental or surgical trauma contributes to this predisposition 2 . Postsurgical immunosuppression may be due to a direct effect of anaesthetic drugs on immune response, hormonal changes evoked by stress, the effect of haemorrhage and transfusion, or the extent of surgical trauma 3±7 . It may also be due to the dysregulation of cytokine production. Hence, plasma levels of interleukin IL) 6 are increased after surgical trauma and are associated with the duration of anaesthesia and operation, the extent of surgical trauma, immune dysfunction, postoperative sys- temic in¯ammatory response syndrome SIRS) and out- come after operation 8 . Moreover, it is controversial whether the circulating level of proin¯ammatory cytokines IL-1b and tumour necrosis factor TNF)) or cytokines involved in an ef®cient cell-mediated immune response IL- 12 and interferon IFN) g) are involved in the postoperative in¯ammatory response 9,10 . In addition, the activity of circulating in¯ammatory cytokines may be modulated by anti-in¯ammatory cytokines 11 . Thus postoperative immunosuppression could be linked to the production of The Editors have satis®ed themselves that all authors have contributed signi®cantly to this publication Original article 1450 ã 2002 Blackwell Science Ltd British Journal of Surgery 2002, 89, 1450±1456