2). All patients were admitted to the ICU after operation as per our department /Tottori University protocol. The patients were discharged from the ICU when stable according our critical care departmental sellckchem criteria. Table 1 Patient Demographics in ICU After Surgical Treatment of Esophageal Cancer Table 2 Gene Expression Data for Esophageal Cancer Patients in the ICU After POD 14 We measured serum mRNA levels for 14 days postoperatively. Informed consent was obtained from each patient and study protocols followed standard ethical guidelines (Declaration of Helsinki, 1975) and were approved by the institutional review board of Tottori University (approval no.138, no 138 1, 2001; no. 343, 2009). The patients consisted of 3 females (mean age 67.3 years, age range 49 to 82 years) and 24 males (mean age 65 years, age range 40-76).

All patients were classified as American Society of Anesthesiologists (ASA) physical status 1 or 2. Patients were prospectively followed for 12 months postoperatively. SIRS or ARDS were diagnosed according to accepted consensus definitions [41,42]. Clinicopathological findings, such as age, diagnosis, etiology, prognosis, effect of the neutrophil elastase inhibitor sivelestat (4.8 mg/kg/day), total days of ventilator dependence (DVD), total days of ICU stay, preoperative CRP levels (preCRP), CRP levels at postoperative day (POD) 1, peak concentrations of CRP (peak CRP), operation duration, anesthesia duration, PaO2/FiO2 ratio at POD 1, days of SIRS, sequential organ failure assessment (SOFA) scores at POD 1, and mortality at 30 days, 6 months, and 1 year were recorded.

Anesthesia consisted of general anesthesia and epidural anesthesia. After surgery, all patients were reintubated with single-lumen endotracheal tubes from the double-lumen endotracheal tubes used intraoperatively and received ventilator support in ICU. Serum from whole blood was obtained intraoperatively and on POD 1, POD 3, POD 5 and POD 14. We measured serum mRNA levels of 11 genes (MMP9, CRP, HMGB1, MUC1, EGR1, PBEF1, PDGFA, TGF-��1, TNF-��, VWF, and IL-6). Sivelestat was prophylactically administered intravenously by the judgment of the attending physician and according to the manufacturer’s recommendations. We distinguished SIRS from severe non-infectious systemic inflammatory response syndrome (SNISIRS) by examining gene expression (GE) in the serum and synchronizing GE changes with the clinical course of events. Processing of the blood and serum samples was performed after blood Batimastat sampling during the operation and at POD 1, POD 3, POD 5 and POD 14. mRNA quantification was performed as previously described [43]. RNA extraction and real-time RT-PCR RNA was performed after DNase treatment, also reported previously [43-45].