Glycocalyx-Shedding and Inflammatory Reactions Occur Yet Do Not Predict Complications Resulting from an Esophagectomy in an Accelerated Recovery After Surgery Program

Drinhaus, Hendrik; Mallmann, Christoph; Cleff, Corvin; Neumann, Tobias; Daniels, Christina; Bruns, Christiane J.; Steinbicker, Andrea U.; Schröder, Wolfgang; Annecke, Thorsten

doi:10.3390/jcm14176048

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Glycocalyx-Shedding and Inflammatory Reactions Occur Yet Do Not Predict Complications Resulting from an Esophagectomy in an Accelerated Recovery After Surgery Program

by

Hendrik Drinhaus

^1,*

,

Christoph Mallmann

^2,3,

Corvin Cleff

¹,

Tobias Neumann

^1,4

,

Christina Daniels

¹,

Christiane J. Bruns

²

,

Andrea U. Steinbicker

¹,

Wolfgang Schröder

^2,3 and

Thorsten Annecke

^1,5

¹

Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany

²

Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany

³

Department of General, Visceral and Oncological Surgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, 58455 Witten, Germany

⁴

Private Practice for Family Medicine familienmedizin.koeln, 50829 Cologne, Germany

⁵

Cologne Merheim Medical Center, Department of Anaesthesiology and Intensive Care Medicine, University of Witten/Herdecke, 58455 Witten, Germany

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(17), 6048; https://doi.org/10.3390/jcm14176048 (registering DOI)

Submission received: 5 August 2025 / Revised: 18 August 2025 / Accepted: 24 August 2025 / Published: 26 August 2025

(This article belongs to the Special Issue Gastrointestinal Cancer: Outcomes and Therapeutic Management)

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Abstract

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.

Keywords: esophagectomy; esophageal cancer; endothelial glycocalyx; CO₂-gap; Interleukins; enhanced recovery after surgery; perioperative complications

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MDPI and ACS Style

Drinhaus, H.; Mallmann, C.; Cleff, C.; Neumann, T.; Daniels, C.; Bruns, C.J.; Steinbicker, A.U.; Schröder, W.; Annecke, T. Glycocalyx-Shedding and Inflammatory Reactions Occur Yet Do Not Predict Complications Resulting from an Esophagectomy in an Accelerated Recovery After Surgery Program. J. Clin. Med. 2025, 14, 6048. https://doi.org/10.3390/jcm14176048

AMA Style

Drinhaus H, Mallmann C, Cleff C, Neumann T, Daniels C, Bruns CJ, Steinbicker AU, Schröder W, Annecke T. 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. 2025; 14(17):6048. https://doi.org/10.3390/jcm14176048

Chicago/Turabian Style

Drinhaus, Hendrik, Christoph Mallmann, Corvin Cleff, Tobias Neumann, Christina Daniels, Christiane J. Bruns, Andrea U. Steinbicker, Wolfgang Schröder, and Thorsten Annecke. 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, no. 17: 6048. https://doi.org/10.3390/jcm14176048

APA Style

Drinhaus, H., Mallmann, C., Cleff, C., Neumann, T., Daniels, C., Bruns, C. J., Steinbicker, A. U., Schröder, W., & Annecke, T. (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), 6048. https://doi.org/10.3390/jcm14176048

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Glycocalyx-Shedding and Inflammatory Reactions Occur Yet Do Not Predict Complications Resulting from an Esophagectomy in an Accelerated Recovery After Surgery Program

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