Drinhaus Hendrik, Mallmann Christoph, Cleff Corvin, Neumann Tobias, Daniels Christina, Bruns Christiane J, Steinbicker Andrea U, Schröder Wolfgang, Annecke Thorsten
Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.
Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.
J Clin Med. 2025 Aug 26;14(17):6048. doi: 10.3390/jcm14176048.
"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 CO-gap as indicators of microcirculatory disturbances. 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 CO-gap was calculated at induction of anesthesia, during laparoscopy, and upon admission to the ICU. Complications (Dindo-Clavien ≥3) occurred in = 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 CO-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). 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 CO-gap could not predict perioperative complications.
食管癌切除术的“术后加速康复”（ARAS）计划旨在缩短围手术期病程，同时不增加发病率或死亡率。在这类计划中，围手术期并发症的预测和早期检测至关重要，因为重症监护病房（ICU）的观察时间有限。我们评估了两种潜在的实验室指标作为术后并发症的预测指标：内皮糖萼脱落以及静脉 - 动脉二氧化碳分压差作为微循环障碍的指标。总共纳入了26例在ARAS计划内接受杂交Ivor Lewis食管癌切除术的患者。通过强化血流动力学监测（脉搏指示连续心输出量监测PiCCO）使大循环状况保持稳定。术前、入住ICU时以及术后第一天测量糖萼脱落参数（多配体蛋白聚糖 - 1、硫酸乙酰肝素、透明质酸）和一组炎症介质。在麻醉诱导期、腹腔镜检查期间以及入住ICU时计算静脉 - 动脉二氧化碳分压差。16例（62%）患者发生了并发症（Dindo-Clavien≥3级）。从术前到入住ICU，多配体蛋白聚糖 - 1（术前29到入住ICU时56 ng/mL）以及白细胞介素1β（1.2到1.4 pg/mL）、6（1.3到19.9 pg/mL）、8（5.2到19.9 pg/mL）和10（0.50到1.33 pg/mL）升高，表明手术期间炎症和糖萼脱落暂时增加。未检测到有并发症和无并发症患者之间的差异。两组之间的静脉 - 动脉二氧化碳分压差也无差异（所有患者中位数为6.8 mmHg，有并发症患者为6.7 mmHg，无并发症患者为7.8 mmHg）。在血流动力学严格控制的ARAS方案下进行食管癌切除术期间出现了微循环功能障碍和炎症迹象。多配体蛋白聚糖 - 1和静脉 - 动脉二氧化碳分压差的增加不能预测围手术期并发症。
