Persistent elevation of plasma vascular endothelial growth factor levels during the first month after minimally invasive colorectal resection |
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Authors: | A Belizon E Balik P Horst D Feingold T Arnell T Azarani V Cekic R Skitt S Kumara R L Whelan |
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Institution: | (1) New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA |
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Abstract: | Background Elevations of plasma vascular endothelial growth factor (VEGF) have been noted early after colorectal resection. The duration
of this increase is unknown. Because VEGF is a potent promoter of angiogenesis, which is critical to tumor growth, a sustained
increase in blood VEGF levels after surgery may stimulate the growth of residual metastases early after surgery. This preliminary
study aimed to determine VEGF levels during the first month after colorectal resection.
Methods Patients from three prospective studies that had late postoperative blood samples available comprised the study population.
Demographic, perioperative, pathologic, and complication data were collected. Plasma samples were obtained preoperatively
for all patients: on postoperative day (POD) 1 for most patients and at varying time points thereafter during the first month
after surgery and beyond. Levels of VEGF were determined via enzyme-linked immunoassay (ELISA) and compared using Wilcoxon’s
matched pairs test. Because the numbers of specimens beyond POD 5 were limited, samples from 7-day time blocks were bundled
and averaged to permit statistical analysis.
Results A total of 49 patients with cancer and 30 patients with benign indications, all of whom underwent minimally invasive colorectal
resection, were assessed separately. With regard to the patients with cancer, the median preoperative plasma value was 150 pg/ml,
and the peak postoperative median value for the POD 14 to 20 time block was 611.1 pg/ml. Furthermore, compared with the preoperative
results, significant VEGF elevations were noted on POD 3 as well as during week 2 (POD 7–13), week 3 (POD 14–20), and week
4 (POD 21–27) (p < 0.05 for each). With regard to the benign patients, the median preoperative VEGF level was 112 pg/ml, and the peak postoperative
value, 286 pg/ml, was noted during postoperative week 2. Significant elevations were noted on POD 3, and for weeks 2 and 3
as well as for POD 28 and later. Between 63% and 89% of the patients at each time point beyond POD 5 had elevated VEGF levels.
Conclusion This preliminary study demonstrates that after minimally invasive colorectal resection for cancer, median VEGF levels are
significantly elevated on POD 3 and remain increased for as long as 4 weeks. Significant elevations in a similar pattern also
were noted for the benign patients. However, the baseline and postoperative median values were lower. The clinical impact
from increased blood levels of VEGF is uncertain. It is possible that the growth of residual tumor deposits may be stimulated
early after surgery. These results warrant a larger study as well as endothelial cell in vitro assays to determine whether
postoperative plasma stimulates proliferation and invasion. |
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Keywords: | Abdominal surgery Angiogenesis Colon cancer Colorectal cancer Colorectal resection Minimally invasive surgery VEGF |
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