Influence of surgical stress on monocytes and complications of infection in patients with esophageal cancer--monocyte HLA-DR antigen expression and respiratory burst capacity.

We investigated how surgical stress affects the phenotypic and functional properties of peripheral blood monocytes, especially the expression of human leukocyte antigen DR (HLA-DR), Mac-1 antigen, and respiratory burst capacity. Then, we analyzed the relation between these monocyte parameters and septic complications following esophagectomy. Increased H2O2 production (605.3 +/- 95.3 fluorescence intensity (FI) vs 441.8 +/- 55.5 FI) in the preoperative period and decreased HLA-DR expression (20.5 +/- 5.5% vs 39.6 +/- 11.1%) on monocytes on the 1st postoperative day (POD) were found in esophagectomy patients (n = 14) compared with gastrectomy patients (n = 29). Furthermore, the level of increased H2O2 production and decreased HLA-DR expression continued on the 8th and 14th POD in the esophagectomy group with septic complications compared with the esophagectomy group without septic complications. These results suggested that patients with septic complications following esophagectomy had alterations of monocyte phenotype and function. This monocyte analysis may contribute to our understanding of the complicated mechanism involved in surgical stress and the development of postoperative septic complications.