Increased serum vascular endothelial growth factor following major surgical injury.

OBJECTIVES: Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis. We evaluated the changes in serum levels of VEGF following major surgical trauma and postoperative inflammatory complications.

MATERIALS AND METHODS: The serum concentration of VEGF was measured with enzyme-linked immunosorbent assay in 41 patients with esophageal cancer who underwent right transthoracic esophagectomy with extensive lymphadenectomy and in 13 patients with gallstones who underwent less-invasive laparoscopic cholecystectomy for comparison. Serum and plasma samples were obtained before the operation and on postoperative days (PODs) 1, 7, 14, 21, and 28. The changes in serum VEGF levels were compared among groups categorized by age, sex, blood loss volume during operation, amount of transfusion, pathological stage of the tumor, and postoperative inflammatory complications. The correlation between serum VEGF levels and inflammatory factors, such as peripheral blood cell count, interleukin-6 (IL-6), C-reactive protein (CRP), and severity of postoperative inflammatory complications, was also investigated. Furthermore, because platelets are a potential source of serum VEGF, platelet-poor plasma (PPP) was prepared from plasma samples, and the VEGF concentration in PPP was measured to compare with those in sera.

RESULTS: Serum VEGF levels increased significantly postoperatively. After reaching maximal levels on POD 14, VEGF levels gradually decreased until POD 28. The increase in the tranthoracic esophagectomy group was approximately twice that in laparoscopic cholecystectomy group on POD 14. Serum VEGF levels were not correlated with sex, age, blood loss, amount of transfusion, or tumor stage. However, serum VEGF levels were significantly higher in patients with postoperative inflammatory lung complications than in patients without such complications, and the maximal level of serum VEGF correlated with the severity of postoperative lung complications. However, there were no significant correlations between the increase in the level of serum VEGF and that of serum IL-6 or CRP. The increase of platelet counts in the peripheral blood correlated with that of the serum VEGF level, and VEGF levels in PPP were significantly lower than those in sera.

CONCLUSIONS: Serum VEGF levels increased in the angiogenesis phase of wound healing following major surgical injury. Platelets are a potential source of increased serum VEGF levels, whereas inflammatory lung complications might also be related to increased serum VEGF levels.