Intraperitoneal cytokine response after major surgery: higher postoperative intraperitoneal versus systemic cytokine levels suggest the gastrointestinal tract as the major source of the postoperative inflammatory reaction

Am J Surg. 2004 Mar;187(3):372-7. doi: 10.1016/j.amjsurg.2003.12.019.


Background: Cytokine response is an important factor in the development of shock and organ failure. The aim of this study was to investigate intraperitoneal (peritoneal) and venous (systemic) postoperative cytokine release after major surgery.

Methods: Major abdominal surgery was performed in 19 patients. Preoperative systemic measurements and postoperative systemic and peritoneal measurements of C-reactive protein (CRP) and the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL-6), and IL-10 were performed.

Results: Significantly higher TNF-alpha, IL-6, and IL-10 peritoneal values were recorded compared with systemic values, whereas peritoneal CRP was significantly decreased. CRP increased significantly over time, whereas postoperative values of IL-6, IL-10, and peritoneal TNF-alpha decreased. Systemic TNF-alpha was constant over time, but values after emergent abdominal surgery showed a more extensive response. An additional effect of surgery and emergent abdominal disease was seen in increased TNF-alpha and IL-10 levels.

Conclusions: Compared with systemic cytokines, peritoneal cytokines respond extensively after major surgery, indicating that measurement of peritoneal cytokines is a more sensible method to determine postoperative inflammatory reaction. A normal postoperative course is characterized by decreasing levels of peritoneal cytokines.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • C-Reactive Protein / analysis
  • Cohort Studies
  • Cytokines / analysis
  • Cytokines / blood*
  • Digestive System / metabolism*
  • Female
  • Gastrointestinal Diseases / pathology
  • Gastrointestinal Diseases / surgery*
  • Humans
  • Inflammation Mediators / blood*
  • Interleukin-10 / blood
  • Interleukin-6 / analysis
  • Male
  • Middle Aged
  • Peritoneal Lavage
  • Postoperative Complications / blood*
  • Postoperative Complications / diagnosis
  • Postoperative Period
  • Preoperative Care
  • Probability
  • Sensitivity and Specificity
  • Surgical Procedures, Operative / adverse effects*
  • Surgical Procedures, Operative / methods
  • Tumor Necrosis Factor-alpha / analysis


  • Cytokines
  • Inflammation Mediators
  • Interleukin-6
  • Tumor Necrosis Factor-alpha
  • Interleukin-10
  • C-Reactive Protein