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Minimally invasive colon resection is associated with a transient increase in plasma sVEGFR1 levels and a decrease in sVEGFR2 levels during the early postoperative period

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Abstract

Introduction

Plasma vascular endothelial growth factor (VEGF) levels are elevated for 2–4 weeks after minimally invasive colorectal resection (MICR). VEGF induces wound and tumor angiogenesis by binding to endothelial cell (EC)-bound VEGF-receptor 1 (VEGFR1) and VEGFR2. Soluble receptors (sVEGFR1, sVEGFR2) sequester VEGF in the blood and decrease VEGF’s proangiogenic effect. The importance of the MICR-related VEGF changes depends on the effect of surgical procedures on sVEGFR1 and sVEGFR2; this study assessed levels of these proteins after MICR for benign indications.

Methods

Blood samples were taken (n = 39) preoperatively (preop) and on postoperative days (POD) 1 and 3; in most cases a fourth sample was drawn between POD 7 and 30. sVEGFR1 and sVEGFR2 levels were measured via enzyme-linked immunosorbent assay (ELISA), which detects free and VEGF bound soluble receptor. Late samples were bundled into POD 7–13 and POD 14–30 time points. Results are reported as mean and standard deviation. The data was assessed with paired-samples t-test.

Results

Preop, mean plasma sVEGFR2 level (9,203.7 ± 1,934.3 pg/ml) was significantly higher than the sVEGFR1 value (132.5 ± 126.2 pg/ml). sVEGFR2 levels were significantly lower on POD 1 (6,957.8 ± 1,947.7 pg/ml,) and POD 3 (7,085.6 ± 2,000.2 pg/ml), whereas sVEGFR1 levels were significantly higher on POD 1 (220.0 ± 132.8 pg/ml) and POD 3 (182.7 ± 102.1 pg/ml) versus preop results. No differences were found on POD 7–13 or 14–30.

Conclusions

sVEGFR2 values decreased and sVEGFR1 levels increased early after MICR; due to its much higher baseline, the sVEGFR2 changes dominate. The net result is less VEGF bound to soluble receptor and more free plasma VEGF.

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Authors and Affiliations

  1. Section of Colon and Rectal Surgery, Department of Surgery, New York-Presbyterian Hospital (Columbia Campus), 177 Fort Washington Avenue, New York, NY, 10032, USA

    H. M. C. Shantha Kumara, J. C. Cabot, A. Hoffman, D. Feingold, R. Baxter & R. Larry Whelan

  2. Division of Colon and Rectal Surgery, Ferguson Clinic, 4100, Lake Dr.SE Suite 205, Grand Rapids, MI, 49546, USA

    M. Luchtefeld

  3. Department of Colorectal Surgery, Cleveland Clinic, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA

    M. F. Kalady

  4. Department of Surgery, Fletcher 465, University of Vermont, College of Medicine, Burlington, VT, 05401, USA

    N. Hyman

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  1. H. M. C. Shantha Kumara
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  2. J. C. Cabot
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  3. A. Hoffman
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  4. M. Luchtefeld
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  7. D. Feingold
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  9. R. Larry Whelan
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Correspondence to R. Larry Whelan.

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Shantha Kumara, H.M.C., Cabot, J.C., Hoffman, A. et al. Minimally invasive colon resection is associated with a transient increase in plasma sVEGFR1 levels and a decrease in sVEGFR2 levels during the early postoperative period. Surg Endosc 23, 694–699 (2009). https://doi.org/10.1007/s00464-008-0323-0

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  • DOI: https://doi.org/10.1007/s00464-008-0323-0

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