Etiology and treatment of postoperative severe infections based on impaired host defense systems in patients with digestive organ cancers

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Correlation between dysfunctions of polymorphonuclear neutrophils(PMN), monocytes and humoral immunity and postoperative infections was studied mainly in patients with esophageal cancer.1. Humoral immunityWhen antibody producing capacity against pneumococcal polysaccharides (PPS) was compared, the levels of anti PPS IgG was significantly lower in patients with infections than those without infections. Serum IgG2 levels which are knouwn to be correlated to anti PPS IgG were also significantly lower in those with infections. Those in whom anti PPS Ig was under 600 EU, or IgG2 was under 500 mg/dl seem to be risky for postoperative infections.2. Cytocidal function of PMNIntracellular killing activity (KI) was generally lower in patients with esophageal cancer while superoxide anion production (SOP) was significantly higher in patients with infections than those without such problems.3. MonocytesPhagocytic index was significantly lower in patients with esphageal cancer while the levels of SOP and cytokine production were significantly enhanced in patients with infections than those without such problems.4. Causes of dysfunctionDyofunctions of PMN and monocytes were associated with protein-calorie malnutrition and chronic obstructive pulmonary diseases.Thus, depressed levels of antibody-producing capacity prior surgery were important as a causative mechanism of postoperative infections in patients with esophageal cancer. Activation of PMN and monocytes was found as enhanced levels of SOP and cytokine-production in throse with postoperative infections and those measurements seemed to be beneficial as a predictive indicator of high-risk patients for postoperative infections.