Introduction: Increased plasma cytokines concentrations, soluble cytokine receptors or cytokine receptor antagonist observed in the circulation of patients with sepsis and MOF often correlated with poor outcome. Measuring of the cytokines serum level in patients with pancreatic carcinoma receiving nutritional support before operation is still not used as a predictive factor of possible postoperative complications. Study was performed to investigate the changes in systemic production of IL-6, sTNFRI and IL-1ra before and following pancreaticoduodenectomy in patients with (C+) and without (C-) postoperative complication receiving perioperative nutrition. Methods: Studies were carried out in 18 patients with pancreatic carcinoma before and on day 1,3 and 7 after pancreaticoduodenectomy (Whipple operation). In 7 patients severe postoperative complications occurred. Because of malnutrition 10 patients were supplied with preoperative enteral and postoperative early enteral nutrition. Serum cytokines concentrations were measured by ELISA test. Results: In C+ group preoperative concentration of sTNF-RI (1362.5±244 pg/ml vs. 2254.8±849 pg/ml, p=0.02) and IL-1ra (328.4±200 pg/ml vs. 2174.2±2669 pg/ml, p=0.0009) was significantly lower compared with C - group receiving nutritional support. There was also a tendency to a diminished level of IL-6 in C+ patients before operation (4.2±4.0 pg/ml vs. 206.8±186 pg/ml, p=0.06). In comparison to preoperative value significantly higher levels of IL-6 and IL-1ra were detected on day 1, 3 and 7 after major surgery in C+ group but not in C- patients. Postoperative sTNF-RI concentration was increased in C+ and C- group. Higher concentrations of sTNF-RI were observed in patients with postoperative complications. There were also a significant correlation between IL-6/IL-1ra (0.67, p=0.004) and IL-6 /sTNF-RI (0.64, p=0.01) serum levels before and after surgery. The differences between postoperative cytokines levels in patients with and without enteral nutritional support were not significant, but preoperative cytokines levels were higher in patients (C- group) receiving nutritional support. Conclusion: We suggest that perioperative nutrition and elevated preoperative cytokines inhibitors serum concentration in patients with pancreatic cancer influence the postoperative inflammatory response to surgical trauma and may protect against SIRS-type reaction and development of serious complications.

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1. Leczenie chirurgiczne wysięku opłucnowego w przebiegu przewlekłego zapalenia trzustki.
2. Zakażenia po endoskopowym protezowaniu dróg żółciowych
3. ZMIANY STĘŻENIA CYTOKIN I ICH INHIBITORÓW ORAZ CHEMOKIN U CHORYCH LECZONYCH Z POWODU CIĘŻKIEJ POSTACI OSTREGO ZAPALENIA TRZUSTKI