Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer.
BACKGROUND AND OBJECTIVES
Gastric ischemic preconditioning has been proposed to improve blood flow and reduce the incidence of anastomotic complications following esophagectomy with gastric pull-up. This study aimed to evaluate the effect of prolonged ischemic preconditioning on the degree of neovascularization in the distal gastric conduit at the time of esophagectomy.


METHODS
A retrospective review of a prospectively maintained database identified 30 patients who underwent esophagectomy. The patients were divided into three groups: control (no preconditioning, n = 9), partial (short gastric vessel ligation only, n = 8), and complete ischemic preconditioning (left and short gastric vessel ligation, n = 13). Microvessel counts were assessed, using immunohistologic analysis to determine the degree of neovascularization at the distal gastric margin.


RESULTS
The groups did not differ in age, gender, BMI, pathologic stage, or cancer subtype. Ischemic preconditioning durations were 163 ± 156 days for partial ischemic preconditioning, compared to 95 ± 50 days for complete ischemic preconditioning (P = 0.2). Immunohistologic analysis demonstrated an increase in microvessel counts of 29% following partial ischemic preconditioning (P = 0.3) and 67% after complete ischemic preconditioning (P < 0.0001), compared to controls.


CONCLUSIONS
Our study indicates that prolonged ischemic preconditioning is safe and does not interfere with subsequent esophagectomy. Complete ischemic preconditioning increased neovascularization in the distal gastric conduit.
['Pham|Thai H|TH|', 'Melton|Shelby D|SD|', 'McLaren|Patrick J|PJ|http://orcid.org/0000-0002-1324-7438', 'Mokdad|Ali A|AA|', 'Huerta|Sergio|S|', 'Wang|David H|DH|', 'Perry|Kyle A|KA|', 'Hardaker|Hope L|HL|', 'Dolan|James P|JP|']
D000368:Aged D002277:Carcinoma D004938:Esophageal Neoplasms D016629:Esophagectomy D005260:Female D006801:Humans D019194:Ischemic Preconditioning D010535:Laparoscopy D008026:Ligation D008297:Male D008875:Middle Aged D018919:Neovascularization, Physiologic D012189:Retrospective Studies D013270:Stomach D016896:Treatment Outcome
esophagectomy preconditioning anastomosis esophageal cancer