Top

Published in:

01-09-2017 | Original Article

Gastric Preconditioning in Advance of Esophageal Resection-Systematic Review and Meta-Analysis

Authors: Patrick Heger, Susanne Blank, Markus K. Diener, Alexis Ulrich, Thomas Schmidt, Markus W. Büchler, André L. Mihaljevic

Published in: Journal of Gastrointestinal Surgery | Issue 9/2017

Abstract

Background

Anastomotic leakage is one of the most severe complications following esophageal resection. Among other strategies, gastric ischemic preconditioning has been proposed to improve anastomotic integrity. The aim of this systematic review is to investigate whether gastric preconditioning has influence on peri- or postoperative outcomes after esophageal resection.

Methods

A systematic literature search was performed to identify studies comparing gastric preconditioning with non-preconditioned patients for any indication of esophageal resection. Random-effects meta-analyses were conducted for main outcomes.

Results

Gastric preconditioning did not reduce anastomotic leakages (OR 0.76; 95%-CI 0.51 to 1.13; p = 0.18), anastomotic strictures (OR 1.10; 95%-CI 0.58 to 2.10; p = 0.76;), major complications (OR 1.14; 95%-CI 0.60 to 2.14; p = 0.69), or in-hospital mortality (OR 0.62; 95%-CI 0.28 to 1.40; p = 0.25). However, preconditioning reduced the rate of severe leaks requiring reoperation (OR 0.20; 95%-CI 0.08 to 0.53; p = 0.001). Increasing the period between preconditioning and esophageal resection over 2 weeks did not reduce anastomotic leakage compared to shorter waiting times (OR 0.65; 95%-CI 0.38 to 1.13; p = 0.13).

Conclusion

With current evidence, gastric preconditioning does not seem to reduce overall rates of anastomotic leakage after esophageal resection but seems to reduce severity of leakages.

Available only for authorised users

Bollschweiler, E, Wolfgarten, E, Gutschow, C, and Holscher, AH, (2001), Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 92 3: p. 549–55.CrossRef

Baquet, CR, Commiskey, P, Mack, K, Meltzer, S, and Mishra, SI, (2005), Esophageal cancer epidemiology in blacks and whites: racial and gender disparities in incidence, mortality, survival rates and histology. J Natl Med Assoc 97 11: p. 1471–8.PubMedPubMedCentral

Lutz, MP, Zalcberg, JR, Ducreux, M, Ajani, JA, Allum, W, Aust, D, Bang, YJ, Cascinu, S, Holscher, A, Jankowski, J, Jansen, EP, Kisslich, R, Lordick, F, Mariette, C, Moehler, M, Oyama, T, Roth, A, Rueschoff, J, Ruhstaller, T, Seruca, R, Stahl, M, Sterzing, F, Van Cutsem, E, Van Der Gaast, A, Van Lanschot, J, Ychou, M, and Otto, F, (2012), Highlights of the EORTC St. Gallen International Expert Consensus on the primary therapy of gastric, gastroesophageal and oesophageal cancer - differential treatment strategies for subtypes of early gastroesophageal cancer. Eur J Cancer 48 16: p. 2941–53.CrossRefPubMed

Ott, K, Bader, FG, Lordick, F, Feith, M, Bartels, H, and Siewert, JR, (2009), Surgical Factors Influence the Outcome After Ivor-Lewis Esophagectomy with Intrathoracic Anastomosis for Adenocarcinoma of the Esophagogastric Junction: A Consecutive Series of 240 Patients at an Experienced Center. Annals of Surgical Oncology 16 4: p. 1017–1025.CrossRefPubMed

Biere, SS, Van Berge Henegouwen, MI, Maas, KW, Bonavina, L, Rosman, C, Garcia, JR, Gisbertz, SS, Klinkenbijl, JH, Hollmann, MW, De Lange, ES, Bonjer, HJ, Van Der Peet, DL, and Cuesta, MA, (2012), Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379 9829: p. 1887–92.CrossRefPubMed

Mcculloch, P, Ward, J, Tekkis, PP, Surgeons, AGO, and British Oesophago-Gastric Cancer, G, (2003), Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 327 7425: p. 1192–7.CrossRefPubMedPubMedCentral

Hulscher, JB, Sandick, JW, Boer, AG, Wijnhoven, BP, Tijssen, JG, Fockens, P, Stalmeier, PF, Kate, FJ, Dekken, H, Obertop, H, Tilanus, HW, and Lanschot, JJ Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. New England journal of medicine, 2002. 347, 1662–9 DOI: 10.1056/NEJMoa022343.CrossRefPubMed

Law, S, Fok, M, Chu, KM, and Wong, J, (1997), Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg 226 2: p. 169–73.CrossRefPubMedPubMedCentral

Beitler, AL and Urschel, JD, (1998), Comparison of stapled and hand-sewn esophagogastric anastomoses. Am J Surg 175 4: p. 337–40.CrossRefPubMed

10.

Briel, JW, Tamhankar, AP, Hagen, JA, Demeester, SR, Johansson, J, Choustoulakis, E, Peters, JH, Bremner, CG, and Demeester, TR, (2004), Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 198 4: p. 536–41; discussion 541-2.CrossRefPubMed

11.

Markar, SR, Arya, S, Karthikesalingam, A, and Hanna, GB, (2013), Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol 20 13: p. 4274–81.CrossRefPubMed

12.

Urschel, JD, (1995), Ischemic conditioning of the rat stomach: implications for esophageal replacement with stomach. J Cardiovasc Surg (Torino) 36 2: p. 191–3.

13.

Akiyama, S, Ito, S, Sekiguchi, H, Fujiwara, M, Sakamoto, J, Kondo, K, Kasai, Y, Ito, K, and Takagi, H, (1996), Preoperative embolization of gastric arteries for esophageal cancer. Surgery 120 3: p. 542–6.CrossRefPubMed

14.

Berrisford, RG, Veeramootoo, D, Parameswaran, R, Krishnadas, R, and Wajed, SA, (2009), Laparoscopic ischaemic conditioning of the stomach may reduce gastric-conduit morbidity following total minimally invasive oesophagectomy. Eur J Cardiothorac Surg 36 5: p. 888–93; discussion 893.CrossRefPubMed

15.

Schroder, W, Holscher, AH, Bludau, M, Vallbohmer, D, Bollschweiler, E, and Gutschow, C, (2010), Ivor-Lewis esophagectomy with and without laparoscopic conditioning of the gastric conduit. World J Surg 34 4: p. 738–43.CrossRefPubMed

16.

Veeramootoo, D, Shore, AC, Shields, B, Krishnadas, R, Cooper, M, Berrisford, RG, and Wajed, SA, (2010), Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy. Surg Endosc 24 5: p. 1126–31.CrossRefPubMed

17.

Diana, M, Hubner, M, Vuilleumier, H, Bize, P, Denys, A, Demartines, N, and Schafer, M, (2011), Redistribution of gastric blood flow by embolization of gastric arteries before esophagectomy. Ann Thorac Surg 91 5: p. 1546–51.CrossRef

18.

Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, and Group, P, (2009), Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6 7: p. e1000097.CrossRefPubMedCentral

19.

Hozo, SP, Djulbegovic, B, and Hozo, I, (2005), Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5 13.CrossRefPubMedPubMedCentral

20.

Lamas, S, Azuara, D, De Oca, J, Sans, M, Farran, L, Alba, E, Escalante, E, and Rafecas, A, (2008), Time course of necrosis/apoptosis and neovascularization during experimental gastric conditioning. Dis Esophagus 21 4: p. 370–6.CrossRefPubMed

21.

Higgins Jpt, GSE, Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.

22.

Higgins, JP, Altman, DG, Gotzsche, PC, Juni, P, Moher, D, Oxman, AD, Savovic, J, Schulz, KF, Weeks, L, Sterne, JA, Cochrane Bias Methods, G, and Cochrane Statistical Methods, G, (2011), The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343 d5928.CrossRefPubMedPubMedCentral

23.

Downs, SH and Black, N, (1998), The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52 6: p. 377–84.CrossRefPubMedPubMedCentral

24.

Metzger, R, Bollschweiler, E, Vallbohmer, D, Maish, M, Demeester, TR, and Holscher, AH, (2004), High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality?. Dis Esophagus 17 4: p. 310–4.CrossRef

25.

Nguyen, NT, Nguyen, XM, Reavis, KM, Elliott, C, Masoomi, H, and Stamos, MJ, (2012), Minimally invasive esophagectomy with and without gastric ischemic conditioning. Surg Endosc 26 6: p. 1637–41.CrossRefPubMed

26.

Dindo, D, Demartines, N, and Clavien, PA, (2004), Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240 2: p. 205–13.CrossRefPubMedCentral

27.

Wajed, SA, Veeramootoo, D, and Shore, AC, (2012), Video. Surgical optimisation of the gastric conduit for minimally invasive oesophagectomy. Surg Endosc 26 1: p. 271–6.CrossRefPubMed

28.

Akiyama, S, Kodera, Y, Sekiguchi, H, Kasai, Y, Kondo, K, Ito, K, and Takagi, H, (1998), Preoperative embolization therapy for esophageal operation. J Surg Oncol 69 4: p. 219–23.CrossRefPubMed

29.

Isomura, T, Itoh, S, Endo, T, Akiyama, S, Maruyama, K, Ishiguchi, T, Ishigaki, T, and Takagi, H, (1999), Efficacy of gastric blood supply redistribution by transarterial embolization: preoperative procedure to prevent postoperative anastomotic leaks following esophagoplasty for esophageal carcinoma. Cardiovasc Intervent Radiol 22 2: p. 119–23.CrossRef

30.

Speicher, PJ, Englum, BR, Ganapathi, AM, Wang, X, Hartwig, MG, D'amico, TA, and Berry, MF, (2016), Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer. Ann Surg.

31.

Biere, SS, Maas, KW, Cuesta, MA, and Van Der Peet, DL, (2011), Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg 28 1: p. 29–35.CrossRefPubMed

32.

Baba, M, Aikou, T, Natsugoe, S, Kusano, C, Shimada, M, Kimura, S, and Fukumoto, T, (1997), Appraisal of ten-year survival following esophagectomy for carcinoma of the esophagus with emphasis on quality of life. World J Surg 21 3: p. 282–5; discussion 286.CrossRefPubMed

33.

Veeramootoo, D, Shore, AC, and Wajed, SA, (2012), Randomized controlled trial of laparoscopic gastric ischemic conditioning prior to minimally invasive esophagectomy, the LOGIC trial. Surg Endosc 26 7: p. 1822–9.CrossRefPubMed

34.

Stahl, M, Mariette, C, Haustermans, K, Cervantes, A, Arnold, D, and Grp, EGW, (2013), Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 24 51–56.CrossRef

35.

Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, DK, Awmf). S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus, Langversion 1.0, 2015, AWMF Registernummer: 021/023OL. 2015; Available from: http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html.

36.

Kuwano, H, Nishimura, Y, Oyama, T, Kato, H, Kitagawa, Y, Kusano, M, Shimada, H, Takiuchi, H, Toh, Y, Doki, Y, Naomoto, Y, Matsubara, H, Miyazaki, T, Muto, M, and Yanagisawa, A, (2015), Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society. Esophagus 12 1–30.CrossRefPubMed

37.

Pham, TH, Perry, KA, Enestvedt, CK, Gareau, D, Dolan, JP, Sheppard, BC, Jacques, SL, and Hunter, JG, (2011), Decreased conduit perfusion measured by spectroscopy is associated with anastomotic complications. Ann Thorac Surg 91 2: p. 380–5.CrossRefPubMed

38.

Perry, KA, Enestvedt, CK, Pham, TH, Dolan, JP, and Hunter, JG, (2010), Esophageal replacement following gastric devascularization is safe, feasible, and may decrease anastomotic complications. J Gastrointest Surg 14 7: p. 1069–73.CrossRef

Title: Gastric Preconditioning in Advance of Esophageal Resection-Systematic Review and Meta-Analysis
Authors: Patrick Heger
Susanne Blank
Markus K. Diener
Alexis Ulrich
Thomas Schmidt
Markus W. Büchler
André L. Mihaljevic
Publication date: 01-09-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 9/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3416-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gastric Preconditioning in Advance of Esophageal Resection-Systematic Review and Meta-Analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2017

A Steatosic Pancreas in a Non-obese Patient

Respiratory Symptoms and Complications of Zenker Diverticulum: Effect of Trans-Oral Septum Stapling

Esophagectomy with Esophagocoloplasty for Malignancies: Indications, Technique (with Video), and Results. Systematic Review of the Literature

Liver Stiffness Assessed by Shear Wave Elastography Predicts Postoperative Liver Failure in Patients with Hepatocellular Carcinoma

Peritoneal Simple Mesothelial Cyst Misdiagnosed as a Gastric Subepithelial Tumor

Interval Magnetic Resonance Imaging: an Alternative to Guidelines for Indeterminate Nodules Discovered in the Cirrhotic Liver