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Gastric Ischemic Conditioning Prior to Esophagectomy Is Associated with Decreased Stricture Rate and Overall Anastomotic Complications

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Gastric ischemic conditioning prior to esophagectomy can increase neovascularization of the new conduit. Prior studies of ischemic conditioning have only investigated reductions in anastomotic leaks. Our aim was to analyze the association between gastric conditioning and all anastomotic outcomes as well as overall morbidity in our cohort of esophagectomy patients.

Methods

We performed a retrospective review of patients undergoing esophagectomy from 2010 to 2015 in a National Cancer Institute designated center. Ischemic conditioning (IC) was performed on morbidly obese patients, those with cardiovascular disease or uncontrolled diabetes, and those requiring feeding jejunostomy and active tobacco users. IC consisted of transection of the short gastric vessels and ligation of the left gastric vessels. Primary outcomes consisted of all postoperative anastomotic complications. Secondary outcomes were overall morbidity.

Results

Two-hundred and seven esophagectomies were performed with an average follow-up of 19 months. Thirty-eight patients (18.4%) underwent conditioning (IC). This group was similar to patients not conditioned (NIC) in age, preoperative pathology, and surgical approach. Five patients in the ischemic conditioning group (13.2%) and 57 patients (33.7%) in the NIC experienced anastomotic complications (p = 0.011). Ischemic conditioning significantly reduced the postoperative stricture rate fourfold (5.3 vs. 20.7% p = 0.02). IC patients experienced significantly fewer complications overall (36.8 vs. 56.2% p = 0.03).

Conclusions

Gastric ischemic conditioning is associated with fewer overall anastomotic complications, fewer strictures, and less morbidity. Randomized studies may determine optimal selection criteria to determine whom best benefits from ischemic conditioning.

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References

  1. Engel, L.S., et al., Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst, 2003. 95(18): p. 1404–13.

    Article  PubMed  Google Scholar 

  2. Njei, B., T.R. McCarty, and J.W. Birk, Trends in esophageal cancer survival in United States adults from 1973 to 2009: A SEER database analysis. J Gastroenterol Hepatol, 2016. 31(6): p. 1141–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bailey, S.H., et al., Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg, 2003. 75(1): p. 217–22; discussion 222.

    Article  PubMed  Google Scholar 

  4. Markar, S.R., et al., Volume-outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000-2011. J Gastrointest Surg, 2012. 16(5): p. 1055–63.

    Article  PubMed  Google Scholar 

  5. Seely, A.J., et al., Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg, 2010. 90(3): p. 936–42; discussion 942.

    Article  PubMed  Google Scholar 

  6. Shen, K.R., et al., Esophagectomy after anti-reflux surgery. J Thorac Cardiovasc Surg, 2010. 139(4): p. 969–75.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Akiyama, S., et al., Preoperative embolization therapy for esophageal operation. J Surg Oncol, 1998. 69(4): p. 219–23.

    Article  PubMed  CAS  Google Scholar 

  8. Law, S., et al., Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg, 1997. 226(2): p. 169–73.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Pham, T.H., et al., Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer. J Surg Oncol, 2017. 116(3): p. 391–397.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kechagias, A., et al., Ischemic Conditioning of the Stomach in the Prevention of Esophagogastric Anastomotic Leakage After Esophagectomy. Ann Thorac Surg, 2016. 101(4): p. 1614–23.

    Article  PubMed  Google Scholar 

  11. Markar, S.R., et al., Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol, 2013. 20(13): p. 4274–81.

    Article  PubMed  Google Scholar 

  12. Ney, A. and R. Kumar, Does preoperative ischaemic conditioning with gastric vessel ligation reduce anastomotic leaks in oesophagectomy? Interact Cardiovasc Thorac Surg, 2014. 19(1): p. 121–4.

    Article  PubMed  Google Scholar 

  13. Charlson, M.E., et al., A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987. 40(5): p. 373–83.

    Article  PubMed  CAS  Google Scholar 

  14. Dhungel, B., et al., Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2008. J Gastrointest Surg, 2010. 14(10): p. 1492–501.

    Article  PubMed  Google Scholar 

  15. Bludau, M., et al., Ischemic conditioning of the gastric conduit prior to esophagectomy improves mucosal oxygen saturation. Ann Thorac Surg, 2010. 90(4): p. 1121–6.

    Article  PubMed  Google Scholar 

  16. Perry, K.A., et al., Gastric ischemic conditioning increases neovascularization and reduces inflammation and fibrosis during gastroesophageal anastomotic healing. Surg Endosc, 2013. 27(3): p. 753–60.

    Article  PubMed  Google Scholar 

  17. Reavis, K.M., et al., Utilization of the delay phenomenon improves blood flow and reduces collagen deposition in esophagogastric anastomoses. Ann Surg, 2005. 241(5): p. 736–45; discussion 745–7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nguyen, N.T., et al., Minimally invasive esophagectomy with and without gastric ischemic conditioning. Surg Endosc, 2012. 26(6): p. 1637–41.

    Article  PubMed  Google Scholar 

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Grant Support

This work was supported, in part, by a grant from the Michael J. Newton Esophageal Cancer Research Foundation.

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Authors and Affiliations

  1. Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park RD, Mail Code: L223A, Portland, OR, 97239, USA

    Steve R. Siegal, Abhishek D. Parmar, Kelly R. Haisley, Brandon H. Tieu, Paul H. Schipper, John G. Hunter & James P. Dolan

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  1. Steve R. Siegal
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  2. Abhishek D. Parmar
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  3. Kelly R. Haisley
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  4. Brandon H. Tieu
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  5. Paul H. Schipper
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  6. John G. Hunter
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  7. James P. Dolan
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Contributions

Steve R. Siegal, MD: conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript

Abhishek D. Parmar, MD, MS: conception and design, analysis and interpretation of data

Kelly Haisley MD: acquisition of data, analysis and interpretation of data

Brandon H. Tieu MD, FACS: conception and design, drafting of the manuscript, critical revision of the manuscript

Paul H. Schipper MD, FACS: conception and design, drafting of the manuscript, critical revision of the manuscript

John G. Hunter, MD, FACS: conception and design, drafting of the manuscript, critical revision of the manuscript

James P. Dolan, MD, MCR, FACS: conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript

Corresponding author

Correspondence to James P. Dolan.

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Siegal, S.R., Parmar, A.D., Haisley, K.R. et al. Gastric Ischemic Conditioning Prior to Esophagectomy Is Associated with Decreased Stricture Rate and Overall Anastomotic Complications. J Gastrointest Surg 22, 1501–1507 (2018). https://doi.org/10.1007/s11605-018-3817-7

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  • DOI: https://doi.org/10.1007/s11605-018-3817-7

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