title: Open surgery induces a dramatic decrease in circulating intact IGFBP-3 in patients with colorectal cancer not seen with laparoscopic surgery.
abstract: BACKGROUND
  As shown earlier by the authors via Western blot analysis, open (OS) but not laparoscopic surgery (LS) induces a qualitative decrease in plasma insulin-like growth factor-binding protein 3 (IGFBP-3) levels on postoperative day 1 (POD 1). Intact IGFBP-3 has tumor suppressive effects, but its degradation products do not. Enzyme linked immunoassay (ELISA) inevitably measures both. In this study, using a novel combined Western blot and ELISA analysis method, precise plasma levels of intact IGFBP-3 on POD2 after open and closed colorectal cancer resection (stage I-III) were determined.
  
  
  METHODS
  This study included 15 OS patients with a mean incision length of 26.7 +/- 15.5 cm and 16 LS patients with a mean incision length of 5.3 +/- 3.1 cm. Intact IGFBP-3 levels were determined via ELISA and Western blot analysis in plasma collected preoperatively and postoperatively.
  
  
  RESULTS
  In the OS patients, the mean preoperative concentration of intact 43-45 kDa IGFBP-3 protein was 1920 +/- 1430 ng/ml. It decreased dramatically on POD2 to 355 +/- 545 ng/ml (p < 0.005). In the LS group, no significant difference was noted between the preoperative level (1305 +/- 807 ng/ml) and the POD2 level (922 + 714 ng/ml).
  
  
  CONCLUSIONS
  Open cancer resection, unlike its minimally invasive alternative, induces a dramatic decrease in concentration of intact IGFBP-3, which may have important implications with regard to colon cancer recurrence.
authors.affiliation: Department of Surgery, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA. ikl39@columbia.edu
authors.forename: I
authors.initials: I
authors.lastname: Kirman
authors.forename: V
authors.initials: V
authors.lastname: Cekic
authors.forename: N
authors.initials: N
authors.lastname: Poltoratskaia
authors.forename: P
authors.initials: P
authors.lastname: Sylla
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.forename: K A
authors.initials: KA
authors.lastname: Forde
authors.forename: R L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D015179:Colorectal Neoplasms / Q000097:blood* / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood*; D010535:Laparoscopy; D008297:Male
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3