Protease/protease inhibitor balance in blood plasma to predict postoperative complications in operated patients with pancreatic head cancer.

Abstract

258 Background: Our purpose was to study the protease/protease inhibitor (P/PI) balance in the blood plasma of patients with cancer of the head of the pancreas before and after pancreatoduodenal resection (PDR) with postoperative complications. Methods: The study was performed using clinical observation, biochemical examinations and statistical analysis in Microsoft Office Excel 2010. The blood plasma of 92 patients with pancreatic head cancer (53 men and 39 women aged 45-76 years, Т2-4N0M0) was studied before the surgery (b/s) and on days 1, 7, 14 and 17 after PDR. The patients were divided into two groups: g1 – 69 patients without postoperative (p/o) complications and g2 – 23 patients with p/o complications: generalization – 7, thrombosis - 8, acute postoperative pancreatitis - 2, gastrostasis - 2, anastomotic leakage - 4 patients. Kinetics of trypsin-like proteases (TLP) and α-1-proteinase inhibitor (α1PI) was studied by spectrophotometry. The data were compared with the blood plasma of 39 healthy donors (N). Results: TLP activity b/s exceeded N in g1 and g2 by 4.1 and 10.6 times; TLP in g2 was 2.6 times higher than in g1. The α1PI activity b/s was higher than N by 1.2 times (p < 0.05) in g1 and lower than N by 2.0 times in g2; α1PI in g2 was 2.4 times lower than in g1. After PDR, activity of TLP increased in all patients on day 1 but decreased on days 7-14 in g1 remaining 2.7 times higher than N by the discharge. The TLP activity in g2 by the discharge was similar to levels b/s and exceeded g1 by 4.4 and N by 12.1 times. The α1PI activity after PDR increased in all patients on days 1-17, but in g1 by the discharge it was similar to N and in g2 it was 1.5 times lower than N. The TLP/α1PI ratio was higher in g2 than in g1 at all times. Conclusions: A high TLP activity and a low α1PI activity, compared to N, were maintained in the blood plasma of all patients with p/o complications, despite their types. The P/PI balance in g2 was shifted to the left being 5.5-9.0 times higher than in g1 at all times which allowed the prognosis of postoperative complications before the surgery, perioperatively or on day 1 after the surgery.