Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience

Abstract

Preoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage.

A Novel Technique to Improve Anastomotic Perfusion Prior to Esophageal Surgery: Hybrid Ischemic Preconditioning of the Stomach. Preclinical Efficacy Proof in a Porcine Survival Model

“…Despite promising results in experimental studies, when translated to humans, IGP has failed to exhibit a clear advantage in terms of AL reduction following esophageal resection [ 10 , 11 , 12 , 13 , 14 ]. Yet, the clinical trials using IGP are highly heterogeneous in terms of technique (angiographic embolization [ 36 , 37 , 38 ] or laparoscopic vessels ligation [ 16 , 18 , 39 , 40 , 41 , 42 ]) and number of vessels involved, and they are mostly of retrospective nature. Importantly, the delay between preconditioning and esophagectomy is largely variable in those studies.…”

“…Authors using an endovascular approach reported better results in terms of increased GCF perfusion [ 36 ] or even AL reduction [ 38 ] as compared to the ones using laparoscopy. In fact, the largest patient series using laparoscopic IGP describe shorter time intervals than 2 weeks [ 40 , 43 ].…”

“…However, the SGAs, which, together with the LGA, participate consistently in the gastric fundus vascular supply [ 45 ], are technically difficult to embolize. In fact, most authors performing angiographic IGP describe a direct embolization of the splenic artery, potentially increasing spleen infarction risk [ 37 , 38 , 46 ]. As a result, we introduced a hybrid laparo-angiographic technique, in which IGP is achieved mainly angiographically, while the SGAs are divided laparoscopically, resulting in a minimization of the surgical manipulation.…”

Ischaemic conditioning of the stomach previous to esophageal surgery

“…Complications of the preoperative arterial embolization have been reported in the literature. The most frequent are mild abdominal pain, nausea and splenic infarction and necrosis (33)(34)(35)37,38). In one case, hospital stay longer than 48 hours was described (37).…”

“…Seven studies describe the experience with percutaneous ischemic conditioning with embolization (10,(33)(34)(35)(36)(37)(38). In all of them, the procedure protocol includes embolization of RGA, LGA and SA, in a variable period before surgery (5 to 21 days).…”