engleski

Postoperative complications after major abdominal cancer surgery and relationship with tumor lymphocyte count

Background and Goal of Study: The patients with advanced malignancy may have impaired immunological response, more postoperative complications and increased mortality. An aim was to compare postoperative complications after major abdominal cancer surgery and patients' survival with CD4+ and CD8+ lymphocytes in tumor and surrounding tissue.Materials and methods: The study included 91 patients of both sexes, aged 18 years, ASA grades 1‐3 who underwent surgery for colorectal, gastric, and pancreatic cancer. Comorbidities were determined using Charlson comorbidity index. Postoperative respiratory and other complications were identified after laboratory and clinical examinations on day 4 postoperative (PO) and outcomes one year after the surgery. Hystological samples taken from all patients were stained using immunohystochemical methods and analyzed under the light microscopy. A number of CD4+ and CD8+ cells in the tumor and in the surrounding tissue were analyzed. Statistical analysis was done Pearson correlation ANOVA. A level of significance of p < 0.05 was considered as statistically significant.Results and discussion: A comorbidity was significant: a history of hypertension in 51.5%, followed diabetes in 13.9%, and COPD 9.9% of patients. Patents with pulmonary comorbidity had highest complication rate and mortality as compared to other patients (P< 0.001). No differences in the lymphocyte number were observed between age, gender or ASA subgroups. A significant correlation was find between Comorbidity index and CD4+ in normal tissue samples (r=0.254, P=0.015). In the patients with Charlson co‐ morbidity index ≥5 a higher number of CD4+ lymphocytes in the control was registered than in the patients with comorbidity index 1‐4 (8±10.08 vs. 4.29±3.68 cells, P=0.018) and in the tumor tissue (9.20±11.47 vs. 4.53±5.82, , P=0.024). CD8+ lymphocytes were not different between two comorbidity groups. CD4+ lymphocytes were higher in the patients with postoperative complications and nonsurvivors, in the normal (6.5±6.2 vs. 4.6±3.5, P=0.04) and in the tumor tissue (8.6±9.7 s. 2.9±3.8, P=0.019) as compared to the patients with uncomplicated recovery respectivelay.Conclusion(s): CD4++ lymphocytes showed a good correlation with patient co‐ morbidities and survival. Specific patients' groups having higher CD4+ infiltration and pulmonary comorbidities may have poor outcome.

complications; postoperative

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