Proinflammatory Cytokines Dynamics at Operation Site and Serum After Breast Surgery

Abstract

Zuhoor K. Al-Gaithy

Objectives: Mastectomy and axillary dissection (AD) provide a good model to study local inflammatory response and wound healing after surgery. The involved factors include pro-inflammatory cytokines. This prospective study investigated kinetic changes of interleukin (IL)-2, IL-6, tumor necrosis factor (TNF)-α in both seroma “wound fluid” and serum during 24 and 48 hours post-mastectomy or lumpectomy, and AD dissection to confirm their roles in inflammatory response and seroma formation. Methods: Twenty-two patients underwent mastectomy or lumpectomy and AD; 11 healthy controls were recruited. Drain fluid (20 ml) and serum were collected postoperatively at 24 and 48 hours. IL-2, IL-6, and TNF-α levels were determined by ELISA kits. Results: After 24 and 48 hours, TNF-α serum levels were significantly higher than controls (P <0.0001); after 48 hours, serum IL-2 and IL-6 were significantly higher than controls (P <0.0001), and serum IL-6 was higher than after 24 hours (P <0.0001). After 24 and 48 hours, wound fluid levels of IL-2 and IL-6 were higher than serum levels of controls (P <0.0001). The IL-6 wound fluid/serum ratio was higher in 24 hours compared to 48 hours (P <0.047). Significant positive correlations were found between serum IL-2 and IL-6 (r=0.477, P <0.002); between wound fluid levels of IL-2 and IL-6 (r=0.379, P <0.011), and between serum and wound fluid TNF-α (r= 0.562, P <0.0001). Conclusions: IL-2, IL-6, and TNF-α are important in wound inflammation and seroma formation after 24 and 48 hours post-breast surgery. Their levels in wound fluid were higher than serum, indicating their local production. IL-2 and IL-6 act synergistically in inflammation and seroma formation.