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Utility of Microvascular Reconstruction in Gastrointestinal Cancer Surgery During Complex Resections and Emergency Salvage

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Major gastrointestinal surgical resections and subsequent reconstruction can occasionally need arterial or venous resection, can encounter variant anatomy, or may lead to injury to vessels. These can lead to arterial and/or venous insufficiency of viscera like the stomach, liver, colon, or spleen. Left unaddressed, these can lead to, partial or total, organ ischemia or necrosis. This can trigger a cascade of systemic clinical complications resulting in significant morbidity or even mortality. The aim of this case series is to highlight the utility of microvascular plastic surgical principles and practices in countering these vascular insufficiencies in emergency situations. Retrospective analysis of consecutive cases from March 2014 to May 2022, where intervention for emergency salvage of viscera was done. Microvascular surgical intervention for the vascular insufficient organ was performed, either by primary repair of vessels, use of interposition vein grafts, or anastomosis to a new source vessel (supercharging/super-drainage). Patients were monitored postoperatively for any signs of necrosis of viscera. Microvascular intervention was done in 21 cases: seven cases of supercharging of the gastric tube following esophagectomy, two cases of stomach salvage following pylorus-preserving pancreatoduodectomy, eight cases of hepatic artery restoration, two cases of splenic artery repair, and one each of colon salvage during coloplasty, etc. We were able to salvage the viscera of 20 cases. Arterial and venous insufficiencies can be predictably and safely reversed by precise microvascular techniques. Potentially, many greater numbers of patients can benefit from a microvascular approach to complex resections, injury, and viscera salvage.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India

    Dushyant Jaiswal, Chirag Bhansali, Abhishek Shitole, Vineet Kumar, Ameya Bindu, Mayur Mantri, Saumya Mathews & Vinay Kant Shankhdhar

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  1. Dushyant Jaiswal
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  2. Chirag Bhansali
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  3. Abhishek Shitole
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  4. Vineet Kumar
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  5. Ameya Bindu
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  6. Mayur Mantri
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  7. Saumya Mathews
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  8. Vinay Kant Shankhdhar
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Contributions

Vinay Kant Shankhdhar, Dushyant Jaiswal, Saumya Mathews, Mayur Mantri, Vineet Kumar, and Ameya Bindu performed the surgeries. Vineet Kumar and Chirah Bhansali had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Abhishek Shitole and Vineet Kumar wrote the manuscript. Vinay Kant Shankhdhar, Dushjant Jaiswal, and Ameya Bindu reviewed the manuscript.

Corresponding author

Correspondence to Vineet Kumar.

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The study was done in adherence to the Declaration of Helsinki protocol. Proper pre-procedure consents were taken for surgery, documentation, and research purposes. Data storage was performed inconsistence with good clinical practice guidelines.

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The authors declare no competing interests.

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Jaiswal, D., Bhansali, C., Shitole, A. et al. Utility of Microvascular Reconstruction in Gastrointestinal Cancer Surgery During Complex Resections and Emergency Salvage. Indian J Surg Oncol (2024). https://doi.org/10.1007/s13193-024-01942-w

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