Universität zu Köln

Drinhaus, Hendrik ORCID: 0000-0001-8435-2246, Mallmann, Christoph, Cleff, Corvin, Neumann, Tobias ORCID: 0000-0003-1858-7236, Daniels, Christina, Bruns, Christiane J. ORCID: 0000-0001-6590-8181, Steinbicker, Andrea U., Schröder, Wolfgang and Annecke, Thorsten ORCID: 0000-0002-2496-4432 (2025). Glycocalyx-Shedding and Inflammatory Reactions Occur Yet Do Not Predict Complications Resulting from an Esophagectomy in an Accelerated Recovery After Surgery Program. Journal of Clinical Medicine, 14 (17). MDPI. ISSN 2077-0383

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Abstract

[Artikel-Nr. 6048] Background/Objectives: “Accelerated Recovery after Surgery” (ARAS) programs for esophagectomy aim to shorten the perioperative course without increases in morbidity or mortality. In such programs, the prediction and early detection of perioperative complications is essential, as ICU observation times are limited. We evaluated two potential laboratory markers as predictors for postoperative complications: shedding of the endothelial glycocalyx and the veno-arterial CO2-gap as indicators of microcirculatory disturbances. Methods: In total, 26 patients undergoing hybrid Ivor Lewis esophagectomy within an ARAS program were included. Macrocirculatory conditions were kept stable by enhanced hemodynamic monitoring (PiCCO). Glycocalyx shedding parameters (Syndecan-1, heparan sulfate, hyaluronic acid) and a panel of inflammatory mediators were measured preoperatively, upon ICU-admission, and on the first postoperative day. The veno-arterial CO2-gap was calculated at induction of anesthesia, during laparoscopy, and upon admission to the ICU. Results: Complications (Dindo-Clavien ≥3) occurred in n = 16 (62%) patients. From preoperatively to admission to the ICU, Syndecan-1 (29 pre-op to 56 ng/mL at ICU-admission) and Interleukins 1b (1.2 to 1.4 pg/mL), 6 (1.3 to 19.9 pg/mL), 8 (5.2 to 19.9 pg/mL), and 10 (0.50 to 1.33 pg/mL) increased, indicating a temporary increase in inflammation and glycocalyx shedding during surgery. A difference between patients with or without complications could not be detected. There was also no difference in the veno-arterial CO2-gap between the two groups (median of 6.8 mmHg in all patients, 6.7 in patients with complications, 7.8 in patients without complications). Conclusions: Signs of microcirculatory dysfunctions and inflammation occurred during esophagectomy within an ARAS protocol with tightly controlled hemodynamics. Increases in Syndecan-1 and the veno-arterial CO2-gap could not predict perioperative complications.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Drinhaus, Hendrik UNSPECIFIED https://orcid.org/0000-0001-8435-2246 UNSPECIFIED Mallmann, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Cleff, Corvin UNSPECIFIED UNSPECIFIED UNSPECIFIED Neumann, Tobias UNSPECIFIED https://orcid.org/0000-0003-1858-7236 UNSPECIFIED Daniels, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, Christiane J. UNSPECIFIED https://orcid.org/0000-0001-6590-8181 UNSPECIFIED Steinbicker, Andrea U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schröder, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Annecke, Thorsten UNSPECIFIED https://orcid.org/0000-0002-2496-4432 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-800620
Identification Number:	10.3390/jcm14176048
Journal or Publication Title:	Journal of Clinical Medicine
Volume:	14
Number:	17
Number of Pages:	13
Date:	26 August 2025
Publisher:	MDPI
ISSN:	2077-0383
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Anästhesiologie und Operative Intensivmedizin > Klinik für Anästhesiologie und Operative Intensivmedizin Faculty of Medicine > Chirurgie > Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language esophagectomy ; esophageal cancer ; endothelial glycocalyx ; CO2-gap ; Interleukins ; enhanced recovery after surgery ; perioperative complications English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80062