Endothelial Glycocalyx Shedding and Hemodynamic Variables During Hepatic and Pancreatic Resection Surgery

Background and Objectives: The endothelial glycocalyx (EG) maintains vascular barrier and homeostasis, but is vulnerable to perioperative stress and ischemia/reperfusion. We evaluated whether central venous pressure (CVP) strategy-low (LCVP, <5 mmHg) versus normal (NCVP, 5-12 mmHg)-and hepatic ischemia/reperfusion during hepatectomy influence perioperative EG shedding in hepatic or pancreatic resections. Materials and Methods: A total of 37 adults, out of 40 screened, (18-80 years) scheduled for elective hepatic or pancreatic resection under propofol-remifentanil anesthesia with invasive hemodynamic monitoring, were allocated by initial CVP to LCVP or NCVP protocols and further stratified by ischemia versus no ischemia. Plasma syndecan-1 and heparan sulfate were quantified by ELISA at predefined timepoints (baseline after induction; intraoperative and 2 h post-op). Statistical analyses included nonparametric tests, Friedman with Bonferroni, and ANCOVA adjusted for baseline; p < 0.05 significant. Results: Thirty-six patients completed analysis (NCVP n = 23; LCVP n = 13). In procedures without ischemia (n = 24; NCVP 16, LCVP 8), heparan sulfate increased over time in both groups; between-group differences in absolute/percentage change were not significant. Syndecan-1 was similar between groups except at 2 h post-op (T3), where LCVP was higher than NCVP (median 9 [11.5] vs. 1.4 [4.5]; p = 0.027). In procedures with ischemia (n = 12; NCVP 7, LCVP 5), neither biomarker differed between CVP groups at any timepoint. A weak negative CVP-stroke volume variation (SVV) correlation was seen at one timepoint (T1: r = -0.363; p = 0.030). Conclusions: Major hepatic/pancreatic surgery is associated with measurable EG shedding. Overall, shedding appeared largely independent of CVP strategy and ischemia/reperfusion status, with a late postoperative rise in syndecan-1 under LCVP in non-ischemia cases suggesting potential endothelial cost of aggressive fluid restriction/vasopressor use. These findings highlight the need to refine hemodynamic targets that balance minimizing bleeding with preserving endothelial integrity and suggest that perioperative fluid and vasopressor management may directly influence glycocalyx preservation.