Endothelial cell dysfunction and postoperative complications in patients with severe mesenteric traction syndrome: A prospective cohort study

Background: Mesenteric traction syndrome (MTS) is characterized by tachycardia, hypotension, and facial flushing during abdominal surgery. Previous studies suggest that severe MTS is associated with increased complications as well as endothelial damage. Whereas MTS was previously diagnosed based on subjective flushing, a recent study has validated an objective measure of facial flushing using laser speckle contrast imaging. However, no studies have yet examined the association between objectively diagnosed severe MTS (qsMTS), endothelial dysfunction, and postoperative complications. Methods: Patients underwent either open pancreatic surgery or open esophagectomy for non-disseminated cancer. qsMTS was measured using laser speckle contrast imaging. Blood samples for endothelial damage and activation (soluble Thrombomodulin, VEGFR1, and Syndecan-1) were collected at predetermined intervals before and after surgery. Results: In total, 61 patients were included, of whom 19 (31%) had qsMTS. qsMTS was associated with a Comprehensive Complication Index ≥26.2 (p = 0.010). No association was found between qsMTS-status and plasma concentrations of soluble Thrombomodulin, Syndecan-1, or VEGFR1 at any time point (p > 0.13 for all). Conclusion: Severe MTS remains a significant risk factor for severe postoperative complications following major abdominal surgery when diagnosed objectively. Although we hypothesized that this association might be partly mediated by increased endothelial damage and activation, our findings do not support this, as no association was observed between circulating endothelial markers and qsMTS or postoperative complications.