Plasma DNA: A Molecular Marker of Surgical Insult and Postoperative Recovery in Esophageal Cancer

Abstract

Aim: To assess plasma DNA changes intraoperatively, to relate plasma DNA to the magnitude of the surgical insult and to monitor the changes during the postoperative recovery period. Material and Method: Prospective study of 35 patients with esophageal cancer who had esophagectomy of different magnitudes: 19 esophagectomy without thoracotomy and 16 esophagectomy with thoracotomy. The plasma DNA was measured prior to surgery, throughout the course of the operation on four different intervals, and on postoperative days 1, 3, 5, and 7. Results: A significant difference was seen in the median plasma DNA intraoperatively between the two groups: esophagectomy without thoracotomy, 507 ng/ml/min (range 211–2,708), esophagectomy with thoracotomy, median 1,098 ng/ml/min (range 295–22,284; p = 0.014). Postoperative complications were identified in 6 patients who demonstrated a significant elevation in plasma DNA on postoperative days 5 and 7. Conclusion: Plasma DNA increases during surgery as a result of cell damage and the rise correlates with the magnitude of surgery. The descent of plasma DNA postoperatively correlates with surgical recovery. Elevation of the plasma DNA during the postoperative period correlates with postoperative complications. Plasma DNA is an objective molecular marker of surgical insult and can be used to monitor postoperative recovery after esophagectomy.

Circulating Nucleic Acids as a Potential Source for Cancer Biomarkers

“…Nevertheless, significantly higher DNA levels were frequently found in cancer patients with distant metastases [1,41,42]. A return of plasma DNA level to normal after the surgery indicated the complete resection of the tumor, for example, in esophageal, colorectal and lung cancer [41,43]. A rise in the plasma DNA level higher than normal during follow-up in patients after surgery suggests recurrent disease [41,43,44].…”

“…A return of plasma DNA level to normal after the surgery indicated the complete resection of the tumor, for example, in esophageal, colorectal and lung cancer [41,43]. A rise in the plasma DNA level higher than normal during follow-up in patients after surgery suggests recurrent disease [41,43,44]. Gautschi et al reported that lung tumor progression after chemotherapy was significantly associated with increasing plasma DNA concentrations [45].…”

“…These data are in accordance with the results from other groups, who detected the significant increase of the cirDNA levels in plasma [48] and serum [49] of gastric cancer patients by fluorescence-based and RIA assays. By amplifying genomic DNA-specific beta-actin, plasma DNA concentrations were found to be increased in esophageal cancer [39,41]. Contrary to these studies, Herrera et al found no difference between plasma DNA levels of control group, including patients with gastroesophageal reflux disease, versus patients with esophageal cancer [50].…”