Belizon Avraham, Balik Emre, Feingold Daniel L, Bessler Marc, Arnell Tracey D, Forde Kenneth A, Horst Patrick K, Jain Suvinit, Cekic Vesna, Kirman Irena, Whelan Richard L
Department of Surgery, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
Ann Surg. 2006 Nov;244(5):792-8. doi: 10.1097/01.sla.0000225272.52313.e2.
Vascular endothelial growth factor (VEGF) is a potent inducer of angiogenesis that is necessary for wound healing and also promotes tumor growth. It is anticipated that plasma levels would increase after major surgery and that such elevations may facilitate tumor growth. This study's purpose was to determine plasma VEGF levels before and early after major open and minimally invasive abdominal surgery.
Colorectal resection for cancer (n = 139) or benign pathology (n = 48) and gastric bypass for morbid obesity (n = 40) were assessed. Similar numbers of open and laparoscopic patients were studied for each indication. Plasma samples were obtained preoperatively and on postoperative days (POD) 1 and 3. VEGF levels were determined via ELISA. The following statistical methods were used: Fisher exact test, unmatched Student t test, Wilcoxon's matched pairs test, and the Mann Whitney U Test with P < 0.05 considered significant.
The mean preoperative VEGF level of the cancer patients was significantly higher than baseline level of benign colon patients. Regardless of indication or surgical method, on POD3, significantly elevated mean VEGF levels were noted for each subgroup. In addition, on POD1, open surgery patients for all 3 indications had significantly elevated VEGF levels; no POD1 differences were noted for the closed surgery patients. At each postoperative time point for each procedure and indication, the open group's VEGF levels were significantly higher than that of the matching laparoscopic group. VEGF elevations correlated with incision length for each indication.
As a group colon cancer patients prior to surgery have significantly higher mean VEGF levels than patients without tumors. Also, both open and closed colorectal resection and gastric bypass are associated with significantly elevated plasma VEGF levels early after surgery. This elevation is significantly greater and occurs earlier in open surgery patients. The duration and clinical importance of this finding is uncertain but merits further study.
血管内皮生长因子（VEGF）是血管生成的强效诱导剂，对伤口愈合至关重要，同时也促进肿瘤生长。预计大手术后血浆水平会升高，且这种升高可能会促进肿瘤生长。本研究的目的是测定大型开放性和微创腹部手术后早期及术前的血浆VEGF水平。
评估了因癌症（n = 139）或良性病变（n = 48）进行的结肠切除术以及因病态肥胖进行的胃旁路手术（n = 40）。针对每种手术指征，研究了数量相近的开放手术和腹腔镜手术患者。术前以及术后第1天和第3天采集血浆样本。通过酶联免疫吸附测定法（ELISA）测定VEGF水平。使用了以下统计方法：Fisher精确检验、非配对学生t检验、Wilcoxon配对检验以及Mann Whitney U检验，P < 0.05被视为具有统计学意义。
癌症患者术前VEGF平均水平显著高于良性结肠患者的基线水平。无论手术指征或手术方式如何，在术后第3天，每个亚组的VEGF平均水平均显著升高。此外，在术后第1天，所有3种手术指征的开放手术患者VEGF水平均显著升高；而腹腔镜手术患者在术后第1天未观察到差异。对于每种手术及手术指征的每个术后时间点，开放手术组的VEGF水平均显著高于相应的腹腔镜手术组。每种手术指征下，VEGF升高与切口长度相关。
总体而言，术前结肠癌患者的VEGF平均水平显著高于无肿瘤患者。此外，开放性和腹腔镜结直肠切除术以及胃旁路手术均与术后早期血浆VEGF水平显著升高相关。这种升高在开放手术患者中更为显著且出现得更早。这一发现的持续时间和临床重要性尚不确定，但值得进一步研究。
