Open Access

Sustained postoperative plasma elevations of plasminogen activator inhibitor‑1 following minimally invasive colorectal cancer resection

  • Authors:
    • H.M.C. Shantha Kumara
    • Poppy Addison
    • Dasuni N. Gamage
    • Erica Pettke
    • Abhinit Shah
    • Xiaohong Yan
    • Vesna Cekic
    • Richard L. Whelan
  • View Affiliations

  • Published online on: December 8, 2021     https://doi.org/10.3892/mco.2021.2461
  • Article Number: 28
  • Copyright: © Kumara et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Plasminogen activator inhibitor‑1 (PAI‑1) is a serine protease inhibitor that inhibits urokinase‑type plasminogen activator and tissue‑type plasminogen activator. PAI‑1 participates in angiogenesis, wound healing and tumor invasion, and additionally regulates endothelial cell proliferation, angiogenesis and tumor growth. The purpose of the present study was to measure plasma PAI‑1 levels perioperatively in patients with colorectal cancer (CRC) undergoing minimally invasive colorectal resection (MICR). Patients with CRC who underwent elective MICR were eligible for the study. All patients were enrolled in an approved data/plasma bank. Patients with preoperative, postoperative day (POD) 1, POD 3, and at least one POD 7‑34 plasma sample collection were studied. Plasma PAI‑1 levels were determined in duplicate using ELISA, and the medians and 95% confidence intervals (CIs) were determined. The correlations between postoperative plasma PAI‑1 levels and length of surgery were evaluated. PAI‑1 levels were compared between patients who underwent laparoscopic‑assisted vs. hand‑assisted surgery. The preoperative PAI‑1 levels of stage I, II, III and IV pathological stage subgroups were also compared. A total of 91 patients undergoing MICR for CRC were studied. The mean incision length was 8.0±3.9 cm, and the length of stay was 6.8±4.3 days. Compared with the median preoperative levels (17.30; 95% CI: 15.63‑19.78 ng/ml), significantly elevated median levels were observed on POD 1 (28.86; 95% CI: 25.46‑31.22 ng/ml; P<0.001), POD 3 (18.87; 95% CI: 17.05‑21.78 ng/ml; P=0.0037), POD 7‑13 (26.97; 95% CI: 22.81‑28.74 ng/ml; P<0.001), POD 14‑20 (25.92; 95% CI: 17.85‑35.89 ng/ml; P=0.001) and POD 21‑27 (22.63; 95% CI: 20.03‑30.09 ng/ml; P<0.001). The PAI‑1 levels in the hand‑assisted group were higher compared with those in the laparoscopic‑assisted group for 4 weeks after surgery; however, a significant difference was found only on POD 1. Therefore, plasma PIA‑1 levels were found to be significantly elevated for 4 weeks after MICR, and the surgery‑related acute inflammatory response may account for the early postoperative PIA‑1 increase. Furthermore, PAI‑1‑associated VEGF‑induced angiogenesis in the healing wounds may account for the late postoperative elevations, and increased PAI‑1 levels may promote angiogenesis in residual tumor deposits.
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February-2022
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Spandidos Publications style
Kumara HS, Addison P, Gamage DN, Pettke E, Shah A, Yan X, Cekic V and Whelan RL: Sustained postoperative plasma elevations of plasminogen activator inhibitor‑1 following minimally invasive colorectal cancer resection. Mol Clin Oncol 16: 28, 2022
APA
Kumara, H.S., Addison, P., Gamage, D.N., Pettke, E., Shah, A., Yan, X. ... Whelan, R.L. (2022). Sustained postoperative plasma elevations of plasminogen activator inhibitor‑1 following minimally invasive colorectal cancer resection. Molecular and Clinical Oncology, 16, 28. https://doi.org/10.3892/mco.2021.2461
MLA
Kumara, H. S., Addison, P., Gamage, D. N., Pettke, E., Shah, A., Yan, X., Cekic, V., Whelan, R. L."Sustained postoperative plasma elevations of plasminogen activator inhibitor‑1 following minimally invasive colorectal cancer resection". Molecular and Clinical Oncology 16.2 (2022): 28.
Chicago
Kumara, H. S., Addison, P., Gamage, D. N., Pettke, E., Shah, A., Yan, X., Cekic, V., Whelan, R. L."Sustained postoperative plasma elevations of plasminogen activator inhibitor‑1 following minimally invasive colorectal cancer resection". Molecular and Clinical Oncology 16, no. 2 (2022): 28. https://doi.org/10.3892/mco.2021.2461