Significance of Peripheral Polymorphonuclear Leukocyte Counts in the Early Period after Gastrointestinal Surgery -With Reference to Serum Cytokine Levels and Organ Dysfunction-

Yoshiaki Murakami, Takashi Yokoyama*, Yuji Imamura, Takashi Kodama, Yoshio Takesue, Takahiro Santo, Kanae Shinbara, Hiroaki Tsumura, Naokuni Tatsumoto, Yuichiro Matsuura

First Department of Surgery, Department of General Medicine*, Hiroshima University School of Medicine

The relationship between the peripheral polymorphonuclear leukocyte (PMN) count in the early postoperative period and serum cytokine (granulocyte colony-stimulating factor (G-CSF) and interleukin 8 (IL-8)) levels of organ dysfunction were investigated in 10 patients each with esophageal cancer, gastric cancer and peritonitis due to perforation of the gastrointestinal tract. The patients with low PMN counts (<7,000/mm³) at 4 hours after surgery (group L) developed organ dysfunction significantly (p<0.01) more often than those with high PMN counts (≥7,000/mm³) at 4 hours after surgery (group H). The serum G-CSF and IL-8 levels of group L were signficantly (p<0.05) higher than those of group H in the early postoperative period. There were significant correlations (p<0.05) between the PMN counts (7,000/mm³ at 4 hours after surgery and degree of organ dysfunction or maximum serum cytokine level. These results suggest that organ dysfunction may be caused in patients with a low PMN count in the early postoperative period because PMNs that are excessively stimulated by hypercytokinemia infiltrate into the tissues, and peripheral PMN counts in the early postoperative period may be a predictor of organ dysfunction after surgery.

Key words
peripheral polymorphonuclear leukocyte counts, organ dysfunction, granulocyte colonystimulating factor, interleukin 8, systemic inflammatory response syndrome

Reprint requests
Yoshiaki Murakami First Department of Surgery, Hiroshima University School of Medicine
1-2-3 Kasumi, Minami-ku, Hiroshima, 734 JAPAN

Accepted
September 13, 1995

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