Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park RD, Mail Code: L223A, Portland, OR, 97239, USA.
J Gastrointest Surg. 2018 Sep;22(9):1501-1507. doi: 10.1007/s11605-018-3817-7. Epub 2018 May 29.
Gastric ischemic conditioning prior to esophagectomy can increase neovascularization of the new conduit. Prior studies of ischemic conditioning have only investigated reductions in anastomotic leaks. Our aim was to analyze the association between gastric conditioning and all anastomotic outcomes as well as overall morbidity in our cohort of esophagectomy patients.
We performed a retrospective review of patients undergoing esophagectomy from 2010 to 2015 in a National Cancer Institute designated center. Ischemic conditioning (IC) was performed on morbidly obese patients, those with cardiovascular disease or uncontrolled diabetes, and those requiring feeding jejunostomy and active tobacco users. IC consisted of transection of the short gastric vessels and ligation of the left gastric vessels. Primary outcomes consisted of all postoperative anastomotic complications. Secondary outcomes were overall morbidity.
Two-hundred and seven esophagectomies were performed with an average follow-up of 19 months. Thirty-eight patients (18.4%) underwent conditioning (IC). This group was similar to patients not conditioned (NIC) in age, preoperative pathology, and surgical approach. Five patients in the ischemic conditioning group (13.2%) and 57 patients (33.7%) in the NIC experienced anastomotic complications (p = 0.011). Ischemic conditioning significantly reduced the postoperative stricture rate fourfold (5.3 vs. 20.7% p = 0.02). IC patients experienced significantly fewer complications overall (36.8 vs. 56.2% p = 0.03).
Gastric ischemic conditioning is associated with fewer overall anastomotic complications, fewer strictures, and less morbidity. Randomized studies may determine optimal selection criteria to determine whom best benefits from ischemic conditioning.
食管切除术前行胃缺血预处理可增加新吻合口的新生血管形成。先前关于缺血预处理的研究仅调查了吻合口漏的减少。我们的目的是分析胃预处理与吻合口所有结局以及我们的食管切除术患者队列中的总发病率之间的关系。
我们对 2010 年至 2015 年在国立癌症研究所指定中心行食管切除术的患者进行了回顾性分析。对病态肥胖患者、有心血管疾病或未控制的糖尿病患者、需要喂养空肠造口术的患者和有吸烟史的患者进行缺血预处理。IC 包括胃短血管的横断和胃左血管的结扎。主要结局包括所有术后吻合口并发症。次要结局为总发病率。
共行 207 例食管切除术，平均随访 19 个月。38 例（18.4%）患者行预处理（IC）。这组患者在年龄、术前病理和手术方式方面与未行预处理（NIC）的患者相似。缺血预处理组 5 例（13.2%）和 NIC 组 57 例（33.7%）患者发生吻合口并发症（p=0.011）。缺血预处理使术后狭窄率降低了四倍（5.3%对 20.7%，p=0.02）。IC 患者的总体并发症发生率明显较低（36.8%对 56.2%，p=0.03）。
胃缺血预处理与总吻合口并发症减少、狭窄减少和发病率降低相关。随机研究可能确定最佳选择标准，以确定谁最受益于缺血预处理。
