Background and Goal of Study: It is now clear that inflammation and cancer initiation are linked. Circulating levels of pro-inflammatory cytokines might be associated with short-term outcome in oncologic patients. IL-2 is a Th1 derived cytokine that induces proliferation and activation of both CD4+ and CD8+ lymphocytes.Different approaches have been proposed to lessen the inflammatory response following colorectal cancer surgery as laparoscopic technique and epidural anesthesia.The aim of this study is to investigate the potential of circulating IL-2 as a prognostic indicator in colorectal cancer. Second objective is to compare IL-2 levels after open surgery with general anesthesia, open surgery with epidural anesthesia and laparoscopic colorectal surgery.
Materials and Methods: Sixty patients were included in this observational, prospective study, twenty in each group. Levels of IL-2 were measured before surgical incision (TO) and on the first (T1), fourth (T4), twenty-fourth (T24) and forty-eight (T48) postoperative hours. Medical history, intraoperative data, postoperative progression, ICU and hospital length of stay, in-hospital and 1-year mortality of all patients were collected.
Results and Discussion: High basal IL-2 plasma levels are significantly associated with higher incidence of postoperative respiratory and infectious complications (p< 0.01), longer ICU and hospital length of stay and higher in-hospital mortality (p< 0.05).IL-2 levels are significantly higher in the control group than in the epidural and laparoscopic groups at all times postoperatively, T1, T4, T24 y T48 (p< 0.01). At T4, IL-2 levels in the epidural group were significantly higher than in laparoscopic group (p< 0.01).
Conclusion(s): High preoperative serum IL-2 levels may reflect the activation of the systemic immune response that is associated with poorer outcome.
The absence of an increase on IL-2 plasma levels postoperatively in the laparoscopic group and to a lesser extent, in the epidural group might reflect an attenuated inflammatory response following colorectal cancer surgery.