Effects of one-lung ventilation time on bronchoalveolar lavage fluid and serum inflammatory markers after radical operation of esophageal cancer: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOU Ruiqin , YE Lin , LI Linjun , ZHANG Cheng , WU Qingchen

Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding author：

ZHOU Ruiqin, Email: 33967714@qq.com

Keywords：

Esophageal cancer; one-lung ventilation; interleukin-6; tumor necrosis factor-α; procalcitonin; pulmonary infection

DOI：

10.7507/1007-4848.201804032

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Objective To investigate the effects of one-lung ventilation time on the concentration of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in the bronchoalveolar lavage fluid (BALF), serum inflammatory markers and early pulmonary infection after radical resection of esophageal cancer. Methods Ninety patients with thoracoscope and laparoscopic radical resection of esophageal carcinoma were chosen. According to the thoracoscope operation time, the patients were divided into 3 groups including a T1 (0.5–1.5 hours) group, a T2 (1.5–2.5 hours) group and a T3 (>2.5 hours) group. Immediately after the operation, the ventilated and collapsed BALF were taken. Enzyme-linked immunosorbent assay (ELISA) method was used to determine the concentration of IL-6 and tumour necrosis TNF-α. The concentrations of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) were measured on the first, third, fifth day after operation. The incidence of pulmonary infection was observed within 3 days after operation. Result The IL-6 values of the right collapsed lung in all groups were higher than those in the left ventilated lung. The TNF-α value of the right collapsed lung in the T2 group and T3 group was higher than that in the left ventilated lung (P<0.05). Compared with in the right collapsed lung, the TNF-α and IL-6 values gradually increased with the the duration of one-lung ventilation (P<0.05). Compared with the left ventilated lung groups, the IL-6 value increased gradually with the duration of one-lung ventilation time (P<0.05). The TNF-α value of the T3 group was higher than that of the T1 and T2 groups (P<0.05). The PCT value of the T3 group was higher than that of the T1 group and T2 group on the third, fifth day after operation (P<0.05). But there was no significant difference in CRP and WBC among the three groups at different time points. The incidence of pulmonary infection in the T3 group was significantly higher than that in the T1 group within 3 days after operation (P<0.05). Conclusion With the extension of one-lung ventilation time, the release of local and systemic inflammatory mediators is increased, and the probability of pulmonary infection is higher.

Citation： ZHOU Ruiqin, YE Lin, LI Linjun, ZHANG Cheng, WU Qingchen. Effects of one-lung ventilation time on bronchoalveolar lavage fluid and serum inflammatory markers after radical operation of esophageal cancer: A prospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 855-859. doi: 10.7507/1007-4848.201804032 Copy

1.	Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
2.	Sylvester JT. Hypoxic pulmonary vasoconstriction: a radical view. Circ Res, 2001, 88(12): 1228-1230.
3.	艾波, 付向宁, 严华, 等. 不同术式上段食管癌切除术对肺功能的影响. 中国胸心血管外科临床杂志, 2011, 18(5): 413-416.
4.	Bartels H, Stein HJ, Siewert JR. Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg, 1998, 85(6): 840-844.
5.	周小伟, 万志渝, 殷君太, 等. 食管癌手术围术期肺部感染的高危因素分析及预防. 中国胸心血管外科临床杂志, 2014, 21(5): 649-653.
6.	蓝岚, 古妙宁, 叶靖, 等. 长时间单肺通气对兔两侧肺灌洗液中TNF-α、IL-8的影响. 实用医学杂志, 2012, 28(4): 561-563.
7.	Kisala JM, Ayala A, Stephan RN, et al. A model of pulmonary atelectasis in rats: activation of alveolar macrophage and cytokine release. Am J Physiol, 1993, 264(3 Pt 2): R610-R614.
8.	Luo X, Zhang H, Wei X, et al. Aloin suppresses lipopolysaccharide-Induced Inflammatory response and apoptosis by inhibiting the activation of NF-κB. Molecules, 2018, 23(3): pii: E517.
9.	Han R, Zhang F, Wan C, et al. Effect of perfluorooctane sulphonate-induced Kupffer cell activation on hepatocyte proliferation through the NF-κB/TNF-α/IL-6-dependent pathway. Chemosphere, 2018, 200: 283-294.
10.	Schnabel RM, van der Velden K, Osinski A, et al. Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients. BMC Pulm Med, 2015, 15: 107.
11.	Takeuchi H, Saikawa Y, Oyama T, et al. Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy. World J Surg, 2010, 34(2): 277-284.
12.	Meyer ZC, Schreinemakers JM, Mulder PG, et al. Procalcitonin in the recognition of complications in critically ill surgical patients. J Surg Res, 2014, 187(2): 553-558.
13.	Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med, 2006, 34(7): 1996-2003.
14.	Dai X, Fu C, Wang C, et al. The impact of tracheotomy on levels of procalcitonin in patients without sepsis: a prospective study. Clinics (Sao Paulo), 2015, 70(9): 612-617.
15.	Verhage RJ, Boone J, Rijkers GT, et al. Reduced local immune response with continuous positive airway pressure during one-lung ventilation for oesophagectomy. Br J Anaesth, 2014, 112(5): 920-928.
16.	Leite CF, Calixto MC, Toro IF, et al. Characterization of pulmonary and systemic inflammatory responses produced by lung re-expansion after one-lung ventilation. J Cardiothorac Vasc Anesth, 2012, 26(3): 427-432.
17.	杨为贵, 杨春, 聂文双, 等. 肺功能不全食管癌患者的围手术期处理. 中国胸心血管外科临床杂志, 2011, 18(3): 273-275.

1. Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
2. Sylvester JT. Hypoxic pulmonary vasoconstriction: a radical view. Circ Res, 2001, 88(12): 1228-1230.
3. 艾波, 付向宁, 严华, 等. 不同术式上段食管癌切除术对肺功能的影响. 中国胸心血管外科临床杂志, 2011, 18(5): 413-416.
4. Bartels H, Stein HJ, Siewert JR. Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg, 1998, 85(6): 840-844.
5. 周小伟, 万志渝, 殷君太, 等. 食管癌手术围术期肺部感染的高危因素分析及预防. 中国胸心血管外科临床杂志, 2014, 21(5): 649-653.
6. 蓝岚, 古妙宁, 叶靖, 等. 长时间单肺通气对兔两侧肺灌洗液中TNF-α、IL-8的影响. 实用医学杂志, 2012, 28(4): 561-563.
7. Kisala JM, Ayala A, Stephan RN, et al. A model of pulmonary atelectasis in rats: activation of alveolar macrophage and cytokine release. Am J Physiol, 1993, 264(3 Pt 2): R610-R614.
8. Luo X, Zhang H, Wei X, et al. Aloin suppresses lipopolysaccharide-Induced Inflammatory response and apoptosis by inhibiting the activation of NF-κB. Molecules, 2018, 23(3): pii: E517.
9. Han R, Zhang F, Wan C, et al. Effect of perfluorooctane sulphonate-induced Kupffer cell activation on hepatocyte proliferation through the NF-κB/TNF-α/IL-6-dependent pathway. Chemosphere, 2018, 200: 283-294.
10. Schnabel RM, van der Velden K, Osinski A, et al. Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients. BMC Pulm Med, 2015, 15: 107.
11. Takeuchi H, Saikawa Y, Oyama T, et al. Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy. World J Surg, 2010, 34(2): 277-284.
12. Meyer ZC, Schreinemakers JM, Mulder PG, et al. Procalcitonin in the recognition of complications in critically ill surgical patients. J Surg Res, 2014, 187(2): 553-558.
13. Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med, 2006, 34(7): 1996-2003.
14. Dai X, Fu C, Wang C, et al. The impact of tracheotomy on levels of procalcitonin in patients without sepsis: a prospective study. Clinics (Sao Paulo), 2015, 70(9): 612-617.
15. Verhage RJ, Boone J, Rijkers GT, et al. Reduced local immune response with continuous positive airway pressure during one-lung ventilation for oesophagectomy. Br J Anaesth, 2014, 112(5): 920-928.
16. Leite CF, Calixto MC, Toro IF, et al. Characterization of pulmonary and systemic inflammatory responses produced by lung re-expansion after one-lung ventilation. J Cardiothorac Vasc Anesth, 2012, 26(3): 427-432.
17. 杨为贵, 杨春, 聂文双, 等. 肺功能不全食管癌患者的围手术期处理. 中国胸心血管外科临床杂志, 2011, 18(3): 273-275.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effects of one-lung ventilation time on bronchoalveolar lavage fluid and serum inflammatory markers after radical operation of esophageal cancer: A prospective cohort study

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