Surgeons, surgery, and immunomodulation
J. L. Meakins
Department of Surgery, McGill University, Montreal, Quebec, Canada.
With the definition over the past 15 years of the altered immune state of
surgical patients as a result of disease itself and surgical therapy, there
have been multiple approaches to the modulation of immune status in
experimental or clinical situations, but with conflicting or unhelpful
results. The variable that has never been assessed is the significance of
the surgeon as an immunomodulator. The expediency and the quality of the
surgical act in a variety of surgical diseases have a positive effect on
the immune system. Indeed, the data indicate that correction of shock,
drainage of infection, excision or drainage of necrotic material,
restoration of body composition, and solid basic care all have a positive
influence on patients' immune responses. An immunomodulator might get
credit if the role of surgical care is not properly assessed. A framework
for the study of immunomodulators with the integration of clinical behavior
is outlined.
