ArticlePerioperative medicine (London, England)2023
Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery.
Article in Perioperative medicine (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 7 citations in OpenAlex.
- How hyperoxia affects systemic redox state: insights from PULSE-Ox, a randomised double-blind mechanistic feasibility trial.BJA open · 2026Article
- Effects of major solid cancer surgery on oxidative stress assessed by plasma xanthine oxidase and adenosine deaminase activity : a pilot study.World journal of surgical oncology · 2026Article
- The Role of Biomarkers in Personalized Anesthesia: From Physiological Parameters to Molecular Diagnostics.Biomedicines · 2026Review
- Prognostic value of perioperative gamma-glutamyl transferase trajectories in perihilar cholangiocarcinoma: a multicentre retrospective cohort study.Therapeutic advances in medical oncology · 2026Article
- The effects of major abdominal surgery on skeletal muscle mitochondrial respiration in relation to systemic redox status and cardiopulmonary fitness.Experimental biology and medicine (Maywood, N.J.) · 2025Article
- The Interplay between Perioperative Oxidative Stress and Hepatic Dysfunction after Human Liver Resection: A Prospective Observational Pilot Study.Antioxidants (Basel, Switzerland) · 2024Article
- Uncoupled redox stress: how a temporal misalignment of redox-regulated processes and circadian rhythmicity exacerbates the stressed state.Open biology · 2023Review
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Authors and funding
8 authors at 6 institutions in 1 country.
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Abstract
backgroundTissue injury induces inflammation and the surgical stress response, which are thought to be central to the orchestration of recovery or deterioration after surgery. Enhanced formation of reactive oxygen and nitrogen species accompanies the inflammatory response and triggers separate but integrated reduction/oxidation (redox) pathways that lead to oxidative and/or nitrosative stress (ONS). Quantitative information on ONS in the perioperative period is scarce. This single-centre exploratory study investigated the effects of major surgery on ONS and systemic redox status and their potential associations with postoperative morbidity.
methodsBlood was collected from 56 patients at baseline, end of surgery (EoS) and the first postoperative day (day-1). Postoperative morbidity was recorded using the Clavien-Dindo classification and further categorised into minor, moderate and severe. Plasma/serum measures included markers of lipid oxidation (thiobarbituric acid-reactive substances; TBARS, 4-hydroxynonenal; 4-HNE, 8-iso-prostaglandin F
resultsBoth oxidative stress (TBARS) and nitrosative stress (total nitroso-species) increased from baseline to EoS (+14%, P = 0.003 and +138%, P < 0.001, respectively), along with an increase in overall reducing capacity (+9%, P = 0.03) at EoS and protein-adjusted total free thiols (+12%, P = 0.001) at day-1 after surgery. Nitrite, nitrate and cGMP concentrations declined concomitantly from baseline to day-1. Baseline nitrate was 60% higher in the minor morbidity group compared to severe (P = 0.003). The increase in intraoperative TBARS was greater in severe compared to minor morbidity (P = 0.01). The decline in intraoperative nitrate was more marked in the minor morbidity group compared to severe (P < 0.001), whereas the cGMP decline was greatest in the severe morbidity group (P = 0.006).
conclusionIn patients undergoing major HPB surgery, intraoperative oxidative and nitrosative stress increased, with a concomitant increase in reductive capacity. Baseline nitrate was inversely associated with postoperative morbidity, and the hallmarks of poor postoperative outcome include changes in both oxidative stress and NO metabolism.
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