Hmc Shantha Kumara, PhD1, Xiaohong Y Yan, PhD1, Abhinit Shah, MD1, Erica Pettke, MD1, Vesna Cekic, RN1, Kathryn Baxter, NP2, Richard L Whelan, MD2. 1Department of Surgery, Mount Sinai West Hospital 1000 Tenth Avenue, Room 3B-61 New York, NY 10019, 2Department of Surgery,Mount Sinai West Hospital,425 West 59th Street,Suite 7B,New York,NY 10019
Introduction: Minimally Invasive Colorectal Resection (MICR) for malignant and benign indications is associated with significant increases in plasma levels of 12 proangigenic proteins for up to 1 month which may stimulate tumor angiogenesis and growth in patients with residual cancer. It is thought that the plasma increases are related to wound healing. It has been shown that levels of 8 proangiogenic proteins (VEGF, Placental Growth Factor [PlGF], Angiopoetin2 [Ang2], Monocyte Chemo-attractant Protein 1(MCP-1), Chitinase 3-like1 [CHI3L1], Osteopontin [OPN], Matrix Metalloproteinase-2 [MMP-2], and MMP-3) in postoperative (postop) pelvic and subcutaneous Wound Fluid (WF) in MICR cancer patients is many fold higher than plasma levels. This study’s purpose was to see if similar WF elevations are noted in benign indication MICR patients.
Method: Patients in an IRB approved data/plasma bank who underwent elective MICR for benign conditions were studied. Clinical and operative data was collected. Besides preop blood samples, postop blood and wound fluid (WF) samples were simultaneously collected on POD 1 and 3. Also, a 3rd sample set was taken for most patients between POD 7-13; these samples were bundled and considered as a single time point. Samples were centrifuged and stored at -80°C. WF was collected via subcutaneous Jackson Pratt (JP) drains placed in the largest incision. Blood and WF levels of the above 8 proteins were determined in duplicate via ELISA. Analysis was done with the Mann Whitney and Wilcoxon signed rank tests.
Results: 21 benign indication patients (diverticulits, 11; benign polyp, 8; other, 2) were studied (mean age 58.2±12.9 years). Laparoscopic (Lap) methods were used in 14 and Hand-assisted Lap in 7; the mean incision length was 7.5±2.7cm; mean OR time 327.9±118.5 min; and mean LOS was 5.7±3.0 days. Plasma levels of all 8 proteins were significantly elevated over their preop baseline on POD 1, 3, and POD7-13. Versus plasma levels, significantly elevated WF levels were noted for all 8 proteins at all time points.
Conclusion: As shown in prior studies, MICR was associated with plasma elevations postop for all 8 proangiogenic proteins at all 3 time points (p<0.05 for all); further, WF levels at the same timepoints were 2-107 x higher than plasma levels. These results suggest the source of the added plasma protein is the surgical wounds and that surgery-related proangiogenic plasma changes are surgical trauma related and are not dependent on the surgical indication. Further studies are warranted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79053
Program Number: P215
Presentation Session: Poster (Non CME)
Presentation Type: Poster
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