Classification and early recognition of gastric conduit failure after minimally invasive esophagectomy

Abstract

Postoperative CRP monitoring is a highly effective, simple method for the early recognition of gastric conduit failure. This new system of classification provides a successful guide to conservative management or revisional surgery.

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

“…Ischemia-related gastric conduit failure may be recognized intraoperatively but more frequently manifests later in the early postoperative period, with significant clinical implications. We have previously classified postoperative gastric conduit failure, suggesting ways to recognize it early [15].…”

“…We have previously proposed a simple managementbased classification [15] of gastric conduit failure observed after MIO ( Fig. 1): Type 1.…”

Surgical optimisation of the gastric conduit for minimally invasive oesophagectomy

“…There are three types of gastric conduit failure, as previously described [19]: I, simple anastomotic leak managed conservatively; II, conduit tip necrosis with loss of viability of 2-5 cm of the gastric conduit, managed by thoracotomy and refashioning of the anastomosis; and III, whole conduit necrosis warranting take-down, formation of a cervical oesophagostomy, and delayed reconstruction with an interposition graft.…”

“…Despite this apparent successful outcome, we were concerned with a perceived higher incidence of ischaemia-related gastric conduit complications noted with this approach [12,16]. As a consequence, we defined and classified the observed patterns of gastric conduit failure observed with minimally invasive oesophagectomy and also proposed an early recognition and management protocol [19]. Incorporation of this protocol has prevented fatal consequences of such complications.…”

Randomized controlled trial of laparoscopic gastric ischemic conditioning prior to minimally invasive esophagectomy, the LOGIC trial

“…Gastric conduit failure (GCF) describes clinicopathological conditions where a variable length of the ''neoesophagus'' becomes critically ischemic, leading to local or global necrosis [14]. Consequences may be limited to a simple, conservatively controlled ''anastomotic leak,'' or more catastrophic and potentially fatal sequelae relating to mediastinal contamination and sepsis [15].…”