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2007 Program and Abstracts | 2007 Posters
There Is a Stepwise Increase in Postoperative Plasma IGFBP-3 Depletion from Laparoscopic-Assisted to Hand-Assisted to Open Colorectal Resections
Aviad Hoffman*, a. Belizon, Daniel Feingold, Tracey Arnell, Irena Kirman, Patrick K. Horst, Mark B. Foster, Richard L. Whelan
Columbia Presbyterian, New York, NY

Introduction: Insulin like growth factor binding protein-3 (IGFBP-3), which binds IGF and induces apoptosis independently, inhibits the growth of many tumors, including colon cancer. Low blood levels have been shown to be a poor prognostic factor for several human cancers. It is the intact IGFBP-3 protein, rather than the degraded form which has the tumor inhibitory properties. It has been documented that open colorectal resection (OC), significantly more so than laparoscopic-assisted resection (LC), is associated with a significant decrease in the plasma IGFBP-3 levels early after surgery that can persist for up to 3 days. This study's purpose was to assess and compare intact plasma IGFBP-3 levels in colorectal cancer patients undergoing hand assisted laparoscopic resection (HAL), LC, or OC.
Methods: Intact IGFBP-3 levels of HAL, LC, and OC cancer patients (pts) were determined preoperatively (PO) and on POD#2 using a combination of ELISA and Western blot analysis. The HAL, OC, and LC IGFBP-3 results were then compared.
Results: A total of 54 pts were studied: HAL, 12 pts; OC, 19 pts; LC, 23 pts. The mean incision sizes for the three groups were OC-21.9cm (range=12-37), LC-5.4cm (range=3-11), and HAL-10.7cm (range=7-15). In the OC group there was a significant decrease in intact plasma IGFBP-3 levels from PO (1749ng/ml +/- 1366ng/ml) to POD#2 (393.8ng/ml +/- 345.8ng/ml, vs. PO; p=0.0002). In contrast, no significant change was noted in the LC group from PO (1148ng/ml +/-779.6ng/ml) to POD#2 (896ng/ml +/- 625.2ng/ml, vs. PO- p=NS). The HAL's pts showed a significant drop in their IGFBP-3 levels on POD#2 (POD#2-979.8ng/ml +/- 717.7 vs. PO-1441ng/ml +/-696.3ng/ml ; p=0.0425). However, the HAL POD#2 levels were significantly higher than OC POD#2 levels (HAL-979.8ng/ml +/- 717.7ng/ml vs. OC-393.8ng/ml +/- 345.8ng/ml; p=0.0084). No difference was found between the LC and the HAL POD#2 levels.
Conclusion: Intact plasma IGFBP-3 levels fall significantly after HAL and OC, however, after LC a non-significant decrease occurs. The HAL POD2 levels, although decreased are significantly greater than the OC results. There is an indirect relationship between length of incision and postop IGFBP-3 levels; this decrease may be related to the extent of abdominal trauma. The clinical importance of the IGFBP-3 decrease noted after OC and HAL has not yet been established, in theory, this depletion may be detrimental for cancer pts with retained tumor cells after surgery.


2007 Program and Abstracts | 2007 Posters
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