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

Abstract

LIC does not translate into an improved perfusion of the gastric conduit tip. The benefits reported from published clinical series suggest that the resistance of the conduit to ischemia occurs through alternative possibly microcellular mechanisms.

Review of Minimally Invasive Esophagectomy and Current Controversies

“…In the LOGIC trial, a randomized controlled trial of laparoscopic gastric ischemic conditioning prior to MIE, perfusion of the gastric conduit tip—as measured by laser Doppler fluximetry—was not improved by conditioning, although the number of study patients was only 16 [38]. …”

Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques?

“…Advantages of minimal access approaches to the esophagus include a lower risk of postoperative chest infection, shorter length of stay, quicker return to work and post-operative recovery [2][3][4]. There are cited disadvantages, including higher rates of gastric conduit necrosis and anastomotic leak [5,6]. In addition, there are increasing reports of diaphragmatic herniation following esophagectomy performed using minimally invasive techniques [7,8].…”

Esophageal Anastomotic Leak

“…Theoretically, exposure of the gastric tip to ischemic conditions prior to the creation of the anastomosis would avoid acute ischemia and improve blood flow at the time of surgery, thereby decreasing leak rates. While some studies have suggested decreased morbidity with this technique, no significant improvement in leak rates have been identified [29][30][31]. To date, a single prospective study has been completed regarding this question.…”

“…To date, a single prospective study has been completed regarding this question. Patients underwent laparoscopic ischemic conditioning followed by minimally invasive esophagectomy, and found no improvement in perfusion of the gastric conduit trip [31]. Further, the concept of intentionally creating ischemia of the conduit has been met with much resistance among surgeons and has failed to gain steam.…”