A Clinical Study on Endotoxemia after Operation for Carcinoma of the Esophagus with Special Reference to the Effect of Preoperative Immunotherapy

Hajime Yonekawa, Shingo Shima, Masayuki Gotoh, Yoshihisa Morisaki, Yutaka Yoshizumi, Yoshiaki Sugiura, Susumu Tanaka

Department of Surgery II, National Defense Medical College

Serum endotoxin in 17 patients who underwent resection of carcinoma of the esophagus was measured before the operation, and just after, and 1, 3, 5, 7 and 14 days after the operation. The patients were divided into two groups; ten patients were controls, and the remaining seven patients received an immunomodulator, OK432 (5KE) 4 to 6 times before surgery (immunotherapy group). The serum endotoxin level of the control patients before surgery was 13.9±9.8 pg/ml, which was significantly increased after the operation with a peak of 37.0±19.9 pg/ml on the lst postoperative day. This significant endotoxemia continued for 5 days, then the endotoxin level returned to the baseline by 14 days after the operation. In the immunotherapy group, serum endotoxin did not show any significant increase after surgery; therefore, serum endotoxin in this group was significantly lower on the lst and 3rd days after surgery than that in the control group. There were no significant differences in platelet counts, total serum complement (CH50), granulocyte elastase, or respiratory index between these two groups after surgery. This discrepancy between endotoxin levels and clinical course may result from either relatively small changes in endotoxin levels after esophagectomy or the lack of specificity of the toxicolor test.

Key words
endotoxin, postoperative endotoxemia, carcinoma of the esophagus, preoperative immunotherapy, OK432

Reprint requests
Hajime Yonekawa Department of Surgery II, National Defense Medical College
3-2 Namiki, Tokorozawa-shi, 359 JAPAN

Accepted
September 12, 1990

To read the PDF file you will need Abobe Reader installed on your computer.