I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy.
IRCCS Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Updates Surg. 2023 Sep;75(6):1633-1643. doi: 10.1007/s13304-023-01601-9. Epub 2023 Jul 27.
Ischemia at the anastomotic site is thought to be a protagonist in the development of anastomosis-related complications while different strategies to overcome this problem have been reported. Gastric ischemic conditioning (GIC) prior to esophagectomy has been described with this intent. Evaluate the effect of GIC on anastomotic complications after esophagectomy. Scopus, Web of Science, MEDLINE, and PubMed were investigated up to March 31st, 2023. We considered articles that appraised short-term outcomes after GIC vs. no GIC in patients undergoing esophagectomy. Anastomotic leak (AL), anastomotic stricture (AS), and gastric conduit necrosis (GCN) were primary outcomes. Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures, whereas 95% confidence intervals (95% CIs) were used to calculate related inference. Fourteen studies (1760 patients) were included. Of those, 732 (41.6%) underwent GIC, while 1028 (58.4%) underwent one-step esophagectomy. Compared with no GIC, GIC was related to a reduced RR for AL (R RR = 0.63; 95% CI 0.47-0.86; p < 0.01) and AS (RR = 0.51; 95% CI 0.29-0.91; p = 0.02), whereas no differences were found for GCN (RR = 0.56; 95% CI 0.19-1.61; p = 0.28). Postoperative pneumonia (RR = 1.09; p = 0.99), overall complications (RR = 0.87; p = 0.19), operative time (SMD - 0.58; p = 0.07), hospital stay (SMD 0.66; p = 0.09), and 30-day mortality (RR = 0.69; p = 0.22) were comparable. GIC prior to esophagectomy seems associated with a reduced risk for AL and AS. Further studies are necessary to identify the subset of patients who can benefit from this procedure, the optimal technique, and the timing of GIC prior to esophagectomy.
吻合口缺血被认为是吻合口相关并发症发展的主角，而克服这个问题的不同策略已经被报道。胃缺血预处理（GIC）在食管切除术前已经被描述过。评估 GIC 对食管切除术后吻合口并发症的影响。截至 2023 年 3 月 31 日，我们调查了 Scopus、Web of Science、MEDLINE 和 PubMed。我们考虑了评估 GIC 与非 GIC 患者短期术后结果的文章。吻合口漏（AL）、吻合口狭窄（AS）和胃管坏死（GCN）是主要结局。风险比（RR）和标准化均数差（SMD）被用作汇总效应量的指标，而 95%置信区间（95%CI）用于计算相关推断。纳入了 14 项研究（1760 例患者）。其中，732 例（41.6%）接受了 GIC，1028 例（58.4%）接受了一步式食管切除术。与非 GIC 相比，GIC 与 AL（RRR=0.63；95%CI 0.47-0.86；p<0.01）和 AS（RR=0.51；95%CI 0.29-0.91；p=0.02）的 RR 降低相关，而 GCN 没有差异（RR=0.56；95%CI 0.19-1.61；p=0.28）。术后肺炎（RR=1.09；p=0.99）、总并发症（RR=0.87；p=0.19）、手术时间（SMD-0.58；p=0.07）、住院时间（SMD 0.66；p=0.09）和 30 天死亡率（RR=0.69；p=0.22）相当。食管切除术前 GIC 似乎与 AL 和 AS 的风险降低相关。需要进一步的研究来确定哪些患者可以从该手术中受益，最佳技术以及食管切除术前 GIC 的最佳时机。
