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The Effect of Laparoscopic Gastric Ischemic Preconditioning Prior to Esophagectomy on Anastomotic Stricture Rate and Comparison with Esophagectomy-Alone Controls

  • Thoracic Oncology
  • Published:
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Abstract

Background

Benign anastomotic stricture is a recognized complication following esophagectomy. Laparoscopic gastric ischemic preconditioning (LGIP) prior to esophagectomy has been associated with decreased anastomotic leak rates; however, its effect on stricture and the need for subsequent endoscopic intervention is not well studied.

Methods

This was a case-control study at an academic medical center using consecutive patients undergoing oncologic esophagectomies (July 2012–July 2022). Our institution initiated an LGIP protocol on 1 January 2021. The primary outcome was the occurrence of stricture within 1 year of esophagectomy, while secondary outcomes were stricture severity and frequency of interventions within the 6 months following stricture. Bivariable comparisons were performed using Chi-square, Fisher’s exact, or Mann–Whitney U tests. Multivariable regression controlling for confounders was performed to generate risk-adjust odds ratios and to identify the independent effect of LGIP.

Results

Of 253 esophagectomies, 42 (16.6%) underwent LGIP prior to esophagectomy. There were 45 (17.7%) anastomotic strictures requiring endoscopic intervention, including three patients who underwent LGIP and 42 who did not. Median time to stricture was 144 days. Those who underwent LGIP were significantly less likely to develop anastomotic stricture (7.1% vs. 19.9%; p = 0.048). After controlling for confounders, this difference was no longer significant (odds ratio 0.46, 95% confidence interval 0.14–1.82; p = 0.29). Of those who developed stricture, there was a trend toward less severe strictures and decreased need for endoscopic dilation in the LGIP group (all p < 0.20).

Conclusion

LGIP may reduce the rate and severity of symptomatic anastomotic stricture following esophagectomy. A multi-institutional trial evaluating the effect of LGIP on stricture and other anastomotic complications is warranted.

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Funding

This work was unfunded.

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Authors and Affiliations

  1. Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Christina M. Stuart MD, Nicole M. Mott MD, MSCR, Adam R. Dyas MD, Anna K. Gergen MD, Benedetto Mungo MD, Martin D. McCarter MD, Simran K. Randhawa MBBS, Elizabeth A. David MD, MAS, John D. Mitchell MD & Robert A. Meguid MD, MPH

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

    Christina M. Stuart MD, Nicole M. Mott MD, MSCR, Adam R. Dyas MD, Sara Byers BS, Anna K. Gergen MD, Simran K. Randhawa MBBS, Elizabeth A. David MD, MAS, John D. Mitchell MD & Robert A. Meguid MD, MPH

  3. Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA

    Sara Byers BS & Robert A. Meguid MD, MPH

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

    Benedetto Mungo MD & Martin D. McCarter MD

  5. St. Anthony Associated Surgeons, Lakewood, CO, USA

    Camille L. Stewart MD

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  1. Christina M. Stuart MD
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Corresponding author

Correspondence to Christina M. Stuart MD.

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Disclosure

John D. Mitchell reports that he performs consulting for Intuitive Surgical, Inc., and Robert A. Meguid reports that he consults for Medtronic, Inc. Camille L. Stewart received salary support from the Early-Stage Surgeon Scientist Program, 1 March 2023–31 October 2023 (NIH/NCI, P30CA046934). Christina M. Stuart, Nicole M. Mott, Adam R. Dyas, Sara Byers, Anna K. Gergen, Benedetto Mungo, Martin D. McCarter, Simran K. Randhawa, and Elizabeth A. David report no conflicts of interest.

Ethical Approval

COMIRB #21-3164, approved 1 September 2023.

Consent for Publication

This work was presented at the Society of Surgical Oncology Annual Meeting, 20–23 March 2024, Atlanta, GA, USA.

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Stuart, C.M., Mott, N.M., Dyas, A.R. et al. The Effect of Laparoscopic Gastric Ischemic Preconditioning Prior to Esophagectomy on Anastomotic Stricture Rate and Comparison with Esophagectomy-Alone Controls. Ann Surg Oncol 31, 4261–4270 (2024). https://doi.org/10.1245/s10434-024-15096-0

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