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01-05-2010

Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy

Authors: Darmarajah Veeramootoo, Angela C. Shore, Beverley Shields, Rakesh Krishnadas, Martin Cooper, Richard G. Berrisford, Shahjehan A. Wajed

Published in: Surgical Endoscopy | Issue 5/2010

Abstract

Background

Minimally invasive esophagectomy (MIO) is now established as a valid alternative to open surgery for the management of esophagogastric cancers. However, a high incidence of ischemia-related gastric conduit failure (ICF) is observed, which is detrimental to any potential benefits of this approach.

Methods

Since April 2004, MIO has been the procedure of choice for esophagogastric resection in the authors’ unit. Data relating to the surgical technique were collected, with a focus on ischemic conditioning by laparoscopic ligation of the left gastric artery (LIC) 2 weeks or 5 days before resection.

Results

A total of 97 patients underwent a planned MIO. Four in-patient deaths (4.1%) occurred, none of which were conduit related, and overall, 20 patients experienced ICF (20.6%). In four patients, ICF was recognized and dealt with at the initial surgery. The remaining 16 patients experienced this complication postoperatively, with 9 (9.3%) of them requiring further surgery. Of the 97 patients, 55 did not undergo ischemic conditioning, and conduit failure was observed in 11 (20%). Thirty-five patients had LIC at 2 weeks, and 2 (5.7%) experienced ICF. All seven patients (100%) who had LIC at 5 days experienced ICF. Timing of ischemic conditioning (p < 0.0001) had a definite impact on the conduit failure rate, and the benefit of ischemic conditioning at 2 weeks compared with no conditioning neared significance (p = 0.07).

Conclusions

Ischemic failure of the gastric conduit significantly impairs recovery after MIO. Ischemic conditioning 2 weeks before surgery may reduce this complication and allow the benefits of this approach to be realized.

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Title: Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy
Authors: Darmarajah Veeramootoo
Angela C. Shore
Beverley Shields
Rakesh Krishnadas
Martin Cooper
Richard G. Berrisford
Shahjehan A. Wajed
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0739-1

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Springer Medicine

Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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