Influence of Surgical Stress on the Immunological Activity in the Patients with Gastric Cancer and an Attempt on the Effect of the Early Recovery by the Pre-operative Immunotherapy

Hajime Kase, Kazuo Kobayashi, Ryoich Honda, Naohiro Washizawa, Yukihiko Satoh, Shigeji Nagasawa, Kenzou Yanagida, Toshihumi Yoshio

The First Department of Surgery, Toho University School of Medicine

Peripheral blood lymphocytes (PBL number), T cell subsets (percentage), PHA- and Con A-induced lymphoblastogenesis and PPD, SU-PS skin tests were measured pre- and postoperatively in 51 patients with gastric cancer and were analyzed in 4 curative surgical groups divided according to the histological stages of cancer and the kind of operative procedure. On the basis of correlations among these parameters, the influence of surgical stress on immunological activity was determined. In many cases, PBL, PHA, Con A, PPD and SU-PS were depressed at PO2W and recovered at PO3M, and a decrease in OKT4 and a reduction in the OKT4/OKT8 ratio were also observed until PO3M, but these recoveries were delayed in the larger surgical groups and advanced stage groups (compared with those of the other groups). On the other hand, in the measurement of the T cell subset using two-color flow cytometry at the same time and during the operation in another 23 patients with gastric cancer, an increase in suppressor T cells (CD11 (+)⋅CD8 (+)), and decrease in helper T cells (CD4 (+)⋅2H4 (-)) and cytotoxic T cells (CDll (-)⋅CD8 (+)) were already demonstrated about 2 hours after the beginning of the operation. Recently, we tried pre-operative immunotherapy using only OK432 in 48 patient with gastric cancer, in an attempt to obtain early recovery. But the planning of the treatment was inadequate to give a clear effect, and especially, in the more advanced cancer groups, the drug did not block the immunosuppression due to the operation. Therefore, more effective pre-operative immunotherapy is nessessary for advanced gastric cancer and the large surgical stress groups.

Key words
surgical stress, immunological parameter, gastric cancer, immunotherapy

Reprint requests
Hajime Kase First Department of Surgery, School of Medicine, Toho University
6-11-1 Omori Nishi, Ota-ku, Tokyo, 143 JAPAN

Accepted
February 13, 1991

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