European Journal of Cardio-Thoracic Surgery, Vol 8, 517-519, Copyright © 1994 by European Association for Cardio-thoracic Surgery
Effect of type of resection on plasma granulocyte elastase levels following surgery for non-small cell lung carcinoma
P Martin, C Gebitekin, NK Gupta, Y Tian, M Ghaffari-Nejad, NR Saunders and DR Walker
Department of Cardiothoracic Surgery, Killingbeck Hospital, Leeds, UK.
The lung is the primary focus of complications associated with adult
respiratory distress syndrome (ARDS) and increased activation of
granulocytes has been implicated in the genesis of ARDS. In the present
study, plasma granulocyte elastase levels were measured in 24 patients
undergoing lung resection for non-small cell lung carcinoma. Pre-, peri-
and post-operative assessments of plasma elastase levels were made of
patients who underwent a partial resection (lobectomy, n = 13) and patients
who underwent a complete lung resection (pneumonectomy, n = 11).
Preoperatively, values were similar for both patient cohorts and did not
differ from those of normal volunteers. However, immediately (1 h)
post-operation, elastase levels in patients who had undergone pneumonectomy
were significantly elevated (300% of baseline value, P < 0.005), whereas
levels were unchanged in lobectomy patients. On the 1st post-operative day
(POD), elastase levels had returned to normal in pneumonectomy patients,
whilst lobectomy patients now exhibited increased plasma elastase levels
which remained marginally increased until the time of discharge (P <
0.05). The determinants of granulocyte activation following lung resection
remain to be elucidated but may potentially relate to ischemic reperfusion
in patients undergoing lobectomy, or alternatively may simply reflect the
extent of manipulation, compression and contusion of lung tissue.
