Pneumonia after esophageal surgery for squamous cell carcinoma : impact of HLA-DR antigen expression on monocytes

Although surgical techniques and perioperative management of esopha- geal surgery have improved remarkably, morbidity and mortality remain high in comparison with those associated with other procedures. Mortality after esophageal surgery is primarily determined by the development of pulmonary complications. This study included 41 patients who underwent esophageal resection and reconstruc- tion for thoracic esophageal cancer. We evaluated changes in the levels of interleukin (IL)-6 and IL-10, the type 1/type 2 T-helper (Th1/Th2) cell balance, and the expression of HLA-DR antigen on the surface of monocytes after surgery. The pneumonia group tended to have undergone surgeries of a longer duration and had higher serum IL-6 levels on postoperative day 1 than the no pneumonia group. However, serum IL-10 levels or the Th1/Th2 cell balance did not differ significantly between the 2 groups. HLA-DR antigen expression on monocytes was significantly lower in the pneumonia group than in the no pneumonia group on postoperative day 3. In conclusion, estimation of operative time, serum IL-6 levels, and HLA-DR expres- sion on monocytes may provide a method for predicting postoperative pneumonia.