Features of the endothelial status in patients with gastric cancer and its impact on surgical treatment outcomes

BACKGROUND: The incidence of gastric cancer is still high and holds the leading place in the structure of oncological pathology in the world. Prognostic aspects in the treatment of generalized forms of gastric cancer are currently under revision.

AIM: To study functional status of vascular endothelium in patients with gastric cancer in perioperative period and evaluate its influence on the outcomes of surgical treatment.

MATERIALS AND METHODS: A prospective, randomized study was conducted from 2009 to 2019. Two populations were studied: healthy individuals (control group, n=40); patients diagnosed with gastric cancer (general group, n=122). Patients with gastric cancer underwent gastrectomy with lymphodissection.

The functional state of the vascular endothelium was studied: the volume of circulating endotheliocytes (CCE); the level of von Willebrand factor (VF) and the degree of endothelium-dependent vasodilation (EDV). To study their prognostic significance we calculated a conventional “cut-off point”.

RESULTS: The general group patients were divided into 2 subgroups: the main group — the laparoscopic access (n=54) and the comparison group — the laparotomy access (n=68).

Endothelial dysfunction (EDF) correction with Glutargin 1.0 g per day in combination with Enalapril 2.5 mg per day was additionally used in the main subgroup.

In the main group, the values of CCE and VF were lower (8.3±3.0 and 84.6±21.3, respectively) and the values of EDV were higher (13.7±3.9) in contrast to the comparison group (p <0.0001).

Use of the EDF correction method in the main group resulted in a 4.4-fold and 5.1-fold decrease in CCE and VF concentrations, respectively, and a 4.3-fold normalization of EDV (p <0.0001). Increase of CCE concentration more than 7.0 per 10³ platelets; PV more than 120 μg/ml, as well as decrease of EDV below 14% in the study stages increased the risk of postoperative complications by 2.9; 1.7 and 1.8 times, respectively (p <0.0001).

The incidence of surgical complications was 19.7% and non-surgical complications 31.1%. Hospital mortality was 3.3% and out-of-hospital mortality with up to three years follow-up was 13.1%.

The number of purulent-septic complications in the main group was 2.9 times lower, and the rate of thrombotic complications was 4 times lower than in the comparison group (p <0.05).

CONCLUSION: Combined use of laparoscopic technique by EDF medication correction reduces manifestations of stress reaction and decreases the potential risk of complications development in the postoperative period. Elevation of CCE, as well as EDV decrease beyond the relevant excision points in patients with gastric cancer in the perioperative period are prognostic predictors of the risk of purulent-septic and thrombotic complications development.