The impact of ulinastatin on postoperative clinical outcomes in patients with gastric cancer: a retrospective cohort analysis.

BACKGROUND

Excessive perioperative inflammation in gastric cancer (GC) surgery contributes to delayed recovery, complications, and impaired immune function. Ulinastatin (UTI) has shown anti-inflammatory effects in other surgical settings, but its role in laparoscopic gastrectomy for GC remains unclear. This study evaluated the effect of intraoperative UTI on postoperative inflammation and early recovery.

METHODS

This retrospective cohort study included 415 adults undergoing elective laparoscopic gastrectomy for primary gastric adenocarcinoma between January 2021 and January 2023. Patients receiving 300,000 units of UTI intravenously intraoperatively (UTI group, n=53) were compared with those who did not (Control group, n=362). Propensity score matching (PSM) (1:1) balanced baseline characteristics. Postoperative inflammatory markers [C-reactive protein (CRP), white blood cell count (WBC), neutrophil count (NEUT)], and liver function indices [aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (Tbil)] were assessed at postoperative day 1 and 3. Linear mixed-effects models analyzed longitudinal changes, and multivariable regression identified predictors of hospital stay.

RESULTS

After matching, 50 patients per group were analyzed. At postoperative day 3, CRP elevation was lower in the UTI group versus Control [mean difference -22.88±24.64 mg/L (mean ± standard deviation); P=0.04]. ALT increase was also reduced (mean difference -20.22±15.20 U/L; P=0.01). However, WBC, NEUT, AST, Tbil, and hospital stay showed no significant differences. Diabetes history was independently associated with prolonged hospitalization [β=3.35; 95% confidence interval (CI): 1.67-4.98; P=0.03].

CONCLUSIONS

Intraoperative UTI attenuates postoperative CRP and ALT elevation, reflecting anti-inflammatory and partial hepatoprotective effects. Integration of UTI into comprehensive perioperative management may enhance clinical recovery.