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Immediate Postoperative High Syndecan-1 is Associated with Short-Term Morbidity and Mortality After Robot-Assisted Esophagectomy: A Prospective Observational Study

  • Thoracic Oncology
  • Published:
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Disruption of the endothelial glycocalyx (EG) is associated with a poor prognosis in various clinical settings. This study aimed to determine the association between immediate postoperative serum syndecan-1 levels, a representative marker for EG degradation, and major postoperative morbidity and mortality in patients undergoing robot-assisted esophagectomy.


Patients who underwent robot-assisted esophagectomy between 2018 and 2022 were prospectively enrolled. The primary outcome was the association between immediate postoperative syndecan-1 levels and the occurrence of major postoperative morbidity and mortality within 30 days of surgery. Patients were classified into low and high syndecan-1 groups based on the optimal cut-off value of syndecan-1 for predicting major morbidity and mortality. A multivariable logistic regression analysis was performed to investigate the risk factors for major morbidity and mortality.


A total of 207 patients were analyzed. Patients with high syndecan-1 levels (≥48 ng/mL) showed a significantly greater incidence of unexpected returns to the operating room and anastomotic leaks and longer durations of hospital and intensive care unit stays than patients with low syndecan-1 levels (<48 ng/mL). Immediate postoperative syndecan-1 levels ≥48 ng/mL (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.23–4.76), American Society of Anesthesiologists physical status ≥III (OR 3.36, 95% CI 1.56–7.22), and current smoker (OR 4.02, 95% CI 1.52–10.61) were independently associated with major morbidity and mortality within 30 days of esophagectomy.


Immediate postoperative syndecan-1 levels ≥48 ng/mL could be used for the early detection of patients at high risk of complications after robot-assisted esophagectomy.

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Correspondence to Dae Joon Kim MD, PhD or So Yeon Kim MD, PhD.

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Hye Jin Kim, Yong Seon Choi, Byung Jo Park, Hye Jung Shin, Soo Yeon Jeon, Dae Joon Kim, and So Yeon Kim have no conflicts of interest to declare.

Informed Patient Consent

Written informed consent was obtained from all patients involved in this study.

Institutional Review Board Approval

The study protocol was approved by the Institutional Review Board of Severance Hospital, Yonsei University Health System, Seoul, Korea (IRB no. 4-2018-0773, 4 October 2018).

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Kim, H.J., Choi, Y.S., Park, B.J. et al. Immediate Postoperative High Syndecan-1 is Associated with Short-Term Morbidity and Mortality After Robot-Assisted Esophagectomy: A Prospective Observational Study. Ann Surg Oncol 30, 5870–5880 (2023).

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