Pulmonary endothelial permeability and circulating neutrophil-endothelial markers in patients undergoing esophagogastrectomy

OBJECTIVEEsophagogastrectomy is an established surgical treatment for esophageal malignancy. The postoperative period may be complicated by the development of acute lung injury syndromes and thus, may provide a useful model in which to study the early pathogenic mechanisms of inflammatory lung injury. DESIGNOpen, prospective study. SETTINGHigh dependency and intensive therapy units. PATIENTSEight healthy male volunteers and 20 patients in the early postoperative period INTERVENTIONSNone. MEASUREMENTS AND MAIN RESULTSThe lung protein accumulation index (PAI) of radiolabeled transferrin was determined by using a portable, double-isotope system. The following circulating inflammatory markers–thought to reflect neutrophil-endothelial activation and injury including circulating neutrophil elastase–soluble L-, E-, and P-selectins and thrombomodulin and von Willebrand factor antigen were assayed from venous blood samples The PAI for healthy volunteers was median −0.5 (range, −1.73 to 0.27) × 10/min and for patients undergoing esophagogastrectomy −0.005 (range, −1.53 to 2.28) × 10/min. There was no statistical difference between the two groups. In the postesophagogastrectomy group, a significant elevation in circulating levels of neutrophil elastase, soluble P- and E-selectin, thrombomodulin, and von Willebrand factor antigen were observed relative to the control group but only circulating plasma elastase demonstrated a significant correlation with the PAI (r = .23, p =.03). CONCLUSIONSThe data suggest patients undergoing esophagogastrectomy develop a inflammatory response but this is not a surrogate of permeability and other factors are likely to determine persistent injury to the alveolar-capillary barrier function in this patient group.