Hmc Shantha Kumara, PhD, Xiaohong Yan, PhD, Sonali A C Herath, BS, Joon J Jang, MD, Myers A Elizabeth, MD, Daniel Kirchoff, MD, Linda Njoh, MS, Vesna Cekic, RN, Richard L Whelan, MD
Division of Colon and Rectal Surgery, Department of Surgery, St Luke-Roosevelt Hospital Center, Suite 7B, 425 West, 59th Street, New York, NY 10019, USA
Introduction: Galectin-3 is a beta-galactoside-binding protein diversely expressed in mammalian cells, including epithelial and immune cells, that is involved in a variety of normal and pathological biologic processes. Gal-3 is synthesized in the cell cytoplasm and is then transported to the nucleus or cell surface; some is secreted intact extracelllularly. Cell surface associated Gal-3 acts as a cell adhesion molecule and promotes cell-cell interaction during cancer development and progression. Increased serum levels of soluble Gal-3 have been noted in patients with colon, breast, and lung cancers. The impact of minimally invasive colorectal resection (MICR) of colorectal cancer (CRC) on blood levels of Gal-3 is unknown. The goal of this study was to evaluate plasma Gal-3 levels during the first month after MICR for CRC.
Method: Perioperative plasma was obtained from an IRB-approved perioperative plasma and data bank. CRC patients who underwent MICR for whom plasma was available were eligible. The clinical, demographic and pathologic data was collected. Plasma samples had been obtained PreOp and at varying postop time points (-800C storage). The late samples were bundled into 4 time periods (POD7-13, POD14-20, POD21-27, and POD 28-64) and considered as single time points. Plasma Gal3 levels were determined in duplicate via ELISA (results are reported as mean ±SD). Analysis was done with the paired t-test (significance p<0.05).
Results: A total of 68 CRC patients who underwent MICR met the inclusion criteria (39 males /29 female, mean ages 68.3 ±11.8 years; 29% rectal and 71% colon lesions). The mean incision length was 7.4±3.2cm and mean length of stay was 5.9±2.3 days. The final cancer staging breakdown was; Stage I, 28%, Stage II, 28%, stage III, 40% and stage IV, 4%.The mean PreOp Gal-3 level was 14.9 ±8.3 ng/ml (n=68). Significantly decreased mean plasma levels were noted on POD 1(11.5±5.3 ng/ml, n= 68, p=0.001), POD3 (10.2±4.0 ng/ml, n= 68, p<0.001), POD7-13(10.8±2.6 ng/ml, n=38, p=0.004) and on POD14-20 (12.5±5.2 ng/ml, n=26, p=0.008) when compared to PreOp levels. Plasma levels returned to the PreOp baseline at the POD 21-27 time point (p=0.213).
Conclusion: MICR in the cancer setting is associated with a 20-32% decrease in plasma Gal-3 levels during the first 3 weeks post surgery after which levels normalize. The consequences of the MICR related Gal-3 decrease is unclear. CRC’s can over express Gal-3, thus, resection may account, in part, for the decrease in blood levels. Although unproven, the return of Gal-3 levels to baseline after the third week may be related to wound healing. Further studies are warranted as well as later sampling during the second and third months after MICR to determine if plasma levels fall to the lower baseline concentrations that have been noted in cancer free pts.
Session: Poster Presentation
Program Number: P100