Pancreatectomy Induces Cancer-Promoting Neutrophil Extracellular Traps

Abby D Ivey; Hillary G Pratt; Britney Niemann; Kristen Ranson; Amanda Puleo; B Matthew Fagan; Pavan Rao; Kaitlyn M Landreth; Tracy W Liu; Brian A Boone

doi:10.1245/s10434-023-14841-1

Pancreatectomy Induces Cancer-Promoting Neutrophil Extracellular Traps

Ann Surg Oncol. 2024 Jan 18. doi: 10.1245/s10434-023-14841-1. Online ahead of print.

Authors

Abby D Ivey¹, Hillary G Pratt¹, Britney Niemann², Kristen Ranson², Amanda Puleo², B Matthew Fagan², Pavan Rao^{2

3}, Kaitlyn M Landreth⁴, Tracy W Liu^{1

4}, Brian A Boone^{5

6

7}

Affiliations

¹ Cancer Cell Biology, West Virginia University, Morgantown, WV, USA.
² Department of Surgery, West Virginia University, Morgantown, WV, USA.
³ Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
⁴ Microbiology, Immunology and Cell Biology, West Virginia University, Morgantown, WV, USA.
⁵ Cancer Cell Biology, West Virginia University, Morgantown, WV, USA. brian.boone@hsc.wvu.edu.
⁶ Department of Surgery, West Virginia University, Morgantown, WV, USA. brian.boone@hsc.wvu.edu.
⁷ Microbiology, Immunology and Cell Biology, West Virginia University, Morgantown, WV, USA. brian.boone@hsc.wvu.edu.

PMID: 38238536
DOI: 10.1245/s10434-023-14841-1

Abstract

Background: Neutrophil extracellular traps (NETs) occur when neutrophil chromatin is decondensed and extruded into the extracellular space in a web-like structure. Originally described as an anti-microbial function, this process has been implicated in the pathogenesis of pancreatic disease. In addition, NETs are upregulated during physiologic wound-healing and coagulation. This study evaluated how the inflammatory response to pancreatic surgery influences NET formation.

Methods: For this study, 126 patients undergoing pancreatectomy gave consent before participation. Plasma was collected at several time points (preoperatively and through the postoperative outpatient visit). Plasma levels of NET markers, including cell-free DNA (cfDNA), citrullinated histone H3 (CitH3), interleukin (IL)-8, IL-6, and granulocyte colony-stimulating factor (G-CSF) were measured using enzyme-linked immunosorbent assay (ELISA). Patient clinical data were retrospectively collected from a prospectively maintained database.

Results: After pancreatic resection, NET markers (cfDNA and CitH3) were elevated, peaking on postoperative days 3 and 4. This increase in NETs was due to an inherent change in neutrophil biology. Postoperatively, NET-inducing cytokines (IL-8, IL-6, and G-CSF) were increased, peaking early in the postoperative course. The patients undergoing the robotic approach had a reduction in NETs during the postoperative period compared with those who underwent the open approach. The patients who experienced a pancreatic leak had an increase in NET markers during the postoperative period.

Conclusions: Pancreatectomy induces cancer-promoting NET formation. The minimally invasive robotic approach may induce fewer NETs, although the current analysis was limited by selection bias. Pancreatic leak resulted in increased NETs. Further study into the potential for NET inhibition during the perioperative period is warranted.

Keywords: Neutrophil extracellular traps; Neutrophils; Pancreatectomy; Pancreatic leak; Robotic approach.

Abstract

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