ASSOCIATION BETWEEN ELEVATED PLASMA GRANULOCYTE-COLONY-STIMULATING FACTOR AND THE DEGREE OF SURGICAL STRESS IN PATIENTS UNDERGOING GASTROINTESTINAL SURGERY

To characterize the changes in perioperative plasma granulocyte colony-stimulating factor (G-CSF) and analyze the effect of surgical stress on its kinetics, 41 patients undergoing gastrointestinal surgery with varying degrees of surgical stress were examined, The plasma levels of G-CSF significantly increased immediately after the operation, probably in response to surgical injury, This elevation was much higher in the 15 esophagectomy patients, at 883 +/- 300 pg/ml on postoperative day (POD) O, than in the 14 gastrectomy patients, with a value of 233 +/- 151 on POD O, (P < 0.01) or in the 12 cholecystectomy patients, with a value of 64 +/- 41 on POD 1 (P < 0.01), These findings led us to conclude that G-CSF levels increase significantly in the immediate postoperative period and are most likely associated with the degree of surgical stress, In addition, we studied the priming effect of G-CSF on polymorphonuclear leukocytes (PMNs). G-CSF enhanced PMN superoxide anion (O-$ over bar 2) production and luminol-dependent chemiluminescence (CL) induced by opsonized zymosan in a dose-dependent manner, A significant enhancement was seen in the G-CSF level (1 ng/ml) which was almost the same as the maximum G-CSF level in the esophagectomy patients, Furthermore, postoperative PMN activation occurred after the elevation of plasma G-CSF, Thus, we propose that elevated G-CSF may act as one of the mediators which activate PMN function postoperatively.