Effects of major solid cancer surgery on oxidative stress assessed by plasma xanthine oxidase and adenosine deaminase activity : a pilot study

Bruno Pastene; Marion Marlinge; Julien Fromonot; Julia Dodivers; Aissatou Pethwol Bah; Amin Ben Lassoued; Nathalie Lalevée; Pascal Alexandre Thomas; David Jérémie Birnbaum; Djamel Mokart; Marc Leone; Laurent Zieleskiewicz; Régis Guieu

doi:10.1186/s12957-026-04250-5

Effects of major solid cancer surgery on oxidative stress assessed by plasma xanthine oxidase and adenosine deaminase activity : a pilot study

World J Surg Oncol. 2026 Feb 12. doi: 10.1186/s12957-026-04250-5. Online ahead of print.

Authors

Bruno Pastene^{1

2}, Marion Marlinge^{3

4}, Julien Fromonot^{3

4}, Julia Dodivers³, Aissatou Pethwol Bah³, Amin Ben Lassoued⁴, Nathalie Lalevée³, Pascal Alexandre Thomas⁵, David Jérémie Birnbaum⁶, Djamel Mokart⁷, Marc Leone^{8

3}, Laurent Zieleskiewicz^{8

3}, Régis Guieu^{3

4}

Affiliations

¹ Department of Anesthesia and Intensive Care, Hôpital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France. bruno.pastene@ap-hm.fr.
² C2VN, Aix Marseille Univ, INSERM, INRAE, Marseille, France. bruno.pastene@ap-hm.fr.
³ C2VN, Aix Marseille Univ, INSERM, INRAE, Marseille, France.
⁴ Laboratory of Biochemistry, Hôpital de la Timone, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France.
⁵ Department of Thoracic Surgery, Hôpital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France.
⁶ Department of Digestive Surgery, Hôpital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France.
⁷ Medical Surgical Intensive Care Unit, Institut Paoli Calmettes, Marseille, France.
⁸ Department of Anesthesia and Intensive Care, Hôpital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France.

PMID: 41680888
DOI: 10.1186/s12957-026-04250-5

Abstract

Introduction: Solid cancers and their surgical treatment are both major sources of oxidative stress (OS), which contributes to adverse clinical outcomes. This study aimed to explore the impact of major solid cancer surgery on plasma OS concentrations by assessing key biomarkers.

Methods: We conducted an exploratory, prospective study including 36 patients undergoing elective major cancer surgery. Pre- and postoperative plasma concentrations of adenosine deaminase (ADA), xanthine oxidase (XO), ischemia-modified albumin (IMA), redox potential (RP), and high-sensitivity troponin T (hs-TnT) were measured. Thirty matched healthy controls were used for comparison.

Results: Preoperative plasma concentrations of ADA, XO, IMA, and RP were significantly elevated in patients, as compared to controls, indicating high baseline oxidative stress. Postoperatively, plasma concentrations of XO, IMA, and RP decreased significantly (p < 0.05) but remained higher than those of controls, while ADA concentrations showed no significant postoperative decrease. The plasma concentration of hs-TnT increased modestly but significantly after surgery (p = 0.003). A negative correlation between preoperative ADA and XO concentration was observed (r = -0.46; p = 0.006).

Conclusion: Solid cancers were associated with elevated plasma expression of OS, which significantly decreased after surgery. However, major surgery itself induces a residual oxidative burden, reflected by an elevation in myocardial biomarkers. The increased levels of OS levels before surgery could fit the cancer-driven "priming/second-hit" framework. The negative correlation between ADA and XO suggests a potential feedback mechanism. These findings bring new insights regarding OS modulation during major solid cancer surgery and warrant further investigation in larger studies.

Keywords: Adenosine deaminase; Anesthesia; Cancer surgery; High-sensitivity troponin T; Ischemia-modified albumin; Oxidative stress; Reactive oxygen species; Redox potential; Solid cancer; Xanthine oxidase.