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Prospective Evaluation of a Universally Applied Laparoscopic Gastric Ischemic Preconditioning Protocol Prior to Esophagectomy with Comparison with Historical Controls

  • Thoracic Oncology
  • Published:
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Abstract

Background

Anastomotic leak after esophagectomy is associated with significant morbidity and mortality. Our institution began performing laparoscopic gastric ischemic preconditioning (LGIP) with ligation of the left gastric and short gastric vessels prior to esophagectomy in all patients presenting with resectable esophageal cancer. We hypothesized that LGIP may decrease the incidence and severity of anastomotic leak.

Methods

Patients were prospectively evaluated following the universal application of LGIP prior to esophagectomy protocol in January 2021 until August 2022. Outcomes were compared with patients who underwent esophagectomy without LGIP from a prospectively maintained database from 2010 to 2020.

Results

We compared 42 patients who underwent LGIP followed by esophagectomy with 222 who underwent esophagectomy without LGIP. Age, sex, comorbidities, and clinical stage were similar between groups. Outpatient LGIP was generally well tolerated, with one patient experiencing prolonged gastroparesis. Median time from LGIP to esophagectomy was 31 days. Mean operative time and blood loss were not significantly different between groups. Patients who underwent LGIP were significantly less likely to develop an anastomotic leak following esophagectomy (7.1% vs. 20.7%, p = 0.038). This finding persisted on multivariate analysis [odds ratio (OR) 0.17, 95% confidence interval (CI) 0.03–0.42, p = 0.029]. The occurrence of any post-esophagectomy complication was similar between groups (40.5% vs. 46.0%, p = 0.514), but patients who underwent LGIP had shorter length of stay [10 (9–11) vs. 12 (9–15), p = 0.020].

Conclusions

LGIP prior to esophagectomy is associated with a decreased risk of anastomotic leak and length of hospital stay. Further, multi-institutional studies are warranted to confirm these findings.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Anna K. Gergen MD, Christina M. Stuart MD, Navin Vigneshwar MD, Helen Madsen MD, John D. Mitchell MD, Elizabeth A. David MD, MAS, Simran Randhawa MD & Robert A. Meguid MD, MPH

  2. Adult and Child Consortium for Health Outcomes Research (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA

    Sara Byers MS & Robert A. Meguid MD, MPH

  3. Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Jocelyn Johnson RN, Kristen Oase PA-C, MS, Nicole Garduno PA-C, Megan Marsh PA-C, Martin D. McCarter MD & Camille L. Stewart MD

  4. Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Akshay Pratap MD

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  1. Anna K. Gergen MD
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Correspondence to Anna K. Gergen MD.

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Supplementary file 1 Laparoscopic gastric ischemic preconditioning surgical technique (MP4 313934 KB)

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Gergen, A.K., Stuart, C.M., Byers, S. et al. Prospective Evaluation of a Universally Applied Laparoscopic Gastric Ischemic Preconditioning Protocol Prior to Esophagectomy with Comparison with Historical Controls. Ann Surg Oncol 30, 5815–5825 (2023). https://doi.org/10.1245/s10434-023-13689-9

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