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Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience

  • Clinical Investigation
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Abstract

Purpose

Surgical esophagectomy is the gold standard treatment of early-stage esophageal cancer. The procedure is complicated with significant morbidity; the most severe complication being the anastomotic leakage. Anastomotic fistulas are reported in 5–25% of cases and are mainly due to gastric transplant ischemia. Here, we report our experience of ischemic pre-conditioning using preoperative arterial embolization (PreopAE) before esophagectomy.

Materials and Methods

The medical records of all patients who underwent oncologic esophagectomy from 2008 to 2015 were retrospectively reviewed. Patients were divided into two groups: patients who received PreopAE, and a control group of patients who did not benefit from ischemic pre-conditioning. The target arteries selected for PreopAE were the splenic artery, left gastric artery, and right gastric artery. Evaluation of the results was based on anastomotic leakage, postoperative mortality, technical success of PreopAE, and complications related to the embolization procedure.

Results

Forty-six patients underwent oncologic esophagectomy with PreopAE and 13 patients did not receive ischemic conditioning before surgery. Thirty-eight PreopAE were successfully performed (83%), but right gastric artery embolization failed for 8 patients. Anastomotic leakage occurred in 6 PreopAE patients (13%) and in 6 patients (46%) in the control group (p = 0.02). The mortality rate was 2% in the PreopAE group and 23% in the control group (p = 0.03). Eighteen patients suffered from partial splenic infarction after PreopAE, all treated conservatively.

Conclusion

Preoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage.

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Acknowledgements

We thank Dr Alison Foote (Grenoble-Alpes University Hospital) for language editing.

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Authors and Affiliations

  1. Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France

    Julien Ghelfi, Ivan Bricault, Gilbert Ferretti & Christian Sengel

  2. Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France

    Pierre-Yves Brichon & Sébastien Guigard

  3. Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Nîmes, 30029, Nîmes Cedex 09, France

    Julien Frandon

  4. Département d’Information Médicale, Pôle de Santé Publique, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France

    Bastien Boussat

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  1. Julien Ghelfi
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  2. Pierre-Yves Brichon
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Correspondence to Julien Ghelfi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ghelfi, J., Brichon, PY., Frandon, J. et al. Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience. Cardiovasc Intervent Radiol 40, 712–720 (2017). https://doi.org/10.1007/s00270-016-1556-2

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  • DOI: https://doi.org/10.1007/s00270-016-1556-2

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