Preoperative embolization of gastric arteries for esophageal cancer

doi:10.1016/S0039-6060(96)80075-4

Surgery

Volume 120, Issue 3, September 1996, Pages 542-546

https://doi.org/10.1016/S0039-6060(96)80075-4 Get rights and content

Background. We developed a novel treatment of preoperative embolization therapy in an attempt to prevent anastomotic leakage after esophageal resection. We report the results of this new treatment.

Methods. Preoperative embolization therapy (PET) was performed in 24 cases of esophageal carcinoma. The femoral artery was punctured, and celiac angiography was performed. The left gastric artery and splenic artery underwent embolization. The right gastric artery then underwent embolization at a site beyond the second or third branch to the gastric wall. With a laser flow meter the stomach tissue blood flow was measured before and after construction of the gastric tube, and the change in blood flow was compared.

Results. The average decrease in gastric blood flow was 23% in patients with PET and 65% in patients without PET. Twenty-one (88%) of 24 cases maintained more than 50% tissue blood flow in patients with PET and in 1 (8%) of 12 in patients without PET (p<0.001 by t test). No serious complications occurred.

Conclusions. Preoperative embolization therapy is a safe and uncomplicated technique, and tissue blood flow in the stomach was better preserved. This new technique is expected to reduce the frequency of anastomotic leakage after esophageal operation.

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Cited by (69)

Esophageal carcinoma: novelties and challenges in surgery
2023, Bulletin du Cancer
Le traitement chirurgical des cancers œsophagiens représente l’un des piliers du traitement curatif de ces cancers. Durant ces dernières années, plusieurs améliorations concernant les voies d’abord chirurgicales et la prise en charge périopératoire de ces patients ont permis de diminuer la morbi-mortalité postopératoire. Ainsi, la centralisation des patients atteints d’un adénocarcinome œsogastrique dans des centres à haut volume, le développement de l’approche mini-invasive chirurgicale et l’amélioration des techniques d’imagerie peropératoire ont abouti à réduire la mortalité, le taux de complication respiratoire majeure et le taux de chylothorax postopératoire. L’optimisation de la prise en charge postopératoire, avec le développement de programme de réhabilitation améliorée après chirurgie a, quant à elle, réduit le taux de complications postopératoires majeures et la durée de séjour des patients. L’objectif de cette revue est de donner un aperçu des nouveautés et des défis concernant la prise en charge chirurgicale des patients atteints d’un cancer œsophagien.
Surgical resection of esophageal carcinoma is one of the mainstays of curative treatment for these cancers. During the last decade, numerous improvements in surgical approaches and perioperative management of these patients have resulted in a decrease in postoperative morbidity and mortality. Thus, centralization of patients with esophagogastric adenocarcinoma in high volume center, development of minimally invasive surgery and improvements in surgical imaging have led to reduce mortality rate, major pulmonary complication rate and postoperative chylothorax rate. Optimization of postoperative management with enhanced recovery programs has meanwhile reduced the rate of major postoperative complication and the hospital length of stay. The objective of this review is to give an overview of novelties and challenges regarding surgical management of patients with esophageal carcinoma.
An invited commentary on “Critical appraisal of gastric conduit ischaemic conditioning (GIC) prior to oesophagectomy: A systematic review and meta-analysis” (Int J Surg 2020; epub ahead of print)
2020, International Journal of Surgery
Critical appraisal of gastric conduit ischaemic conditioning (GIC) prior to oesophagectomy: A systematic review and meta-analysis
2020, International Journal of Surgery
Anastomotic leaks remain a major complication following oesophagectomy, accounting for high morbidity and mortality. Recently, gastric ischaemic conditioning (GIC) has been proposed to improve anastomotic integrity through neovascularisation of the gastric conduit. This systematic review and meta-analysis aim to determine the impact of GIC on postoperative outcomes following oesophagectomy.
A systematic literature search was performed to identify studies reporting GIC for any indication of oesophageal resection up to April 25, 2019. The primary outcome was anastomotic leak. Secondary outcomes were conduit necrosis, anastomotic strictures, overall and major complications or in-hospital mortality. Meta-analyses were conducted using random-effects modelling.
Nineteen studies reported on GIC, of which 13 were comparative studies. GIC was performed through ligation in 13 studies and embolisation in six studies. GIC did not appear to reduce anastomotic leakages (OR 0.80, CI_95: 0.51–1.24, p = 0.3), anastomotic strictures (OR 0.75, CI_95: 0.35–1.60, p = 0.5), overall complications (OR 1.02, CI_95: 0.48–2.16, p = 0.9), major complications (OR 1.06, CI_95: 0.53–2.11, p = 0.9), or in-hospital mortality (OR 0.70, CI_95: 0.32–1.53, p = 0.4). However, GIC was associated with reduced rates of conduit necrosis (OR 0.30, CI_95: 0.11–0.77, p = 0.013).
GIC does not appear to reduce overall rates of anastomotic leakage after oesophagectomy but seems to reduce severity of leakages. More in depth studies are recommended.
Does gastric conditioning decrease the incidence of cervical oesophagogastric anastomotic leakage?
2018, Cirugia Espanola
La reconstrucción esofágica mediante gastroplastia con anastomosis cervical es una técnica una mayor dehiscencia anastomótica remarcable.. El objetivo de este estudio es analizar la incidencia de dehiscencia anastomótica en pacientes sometidos a gastroplastia con anastomosis cervical tras acondicionamiento isquémico angiográfico del tubo gástrico.
Análisis prospectivo de pacientes que se sometieron a acondicionamiento gástrico 2 semanas antes de la reconstrucción esofágica, desde enero de 2001 hasta enero de 2014.
El acondicionamiento se realizó mediante embolización angiográfica de las arterias gástricas izquierda y derecha, y la arteria esplénica.
La variable principal analizada fue la incidencia de dehiscencia anastomótica en pacientes sometidos a gastroplastia con anastomosis cervical.
Las variables secundarias analizadas fueron el éxito del acondicionamiento, las complicaciones tras este procedimiento y postoperatorias, y la duración media de la estancia hospitalaria postacondicionamiento.
El acondicionamiento gástrico se indicó en 97 pacientes, siendo la neoplasia la etiología más frecuente que motivó la reconstrucción esofágica (76%). Se realizaron 96 procedimientos con éxito, la embolización arterial fue completa en 80 (83%). La morbilidad fue del 13%, sin mortalidad. La morbilidad postoperatoria fue del 45%; las complicaciones más frecuentes asociadas a la cirugía fueron los respiratorios. Seis (7%) pacientes presentaron fístula cervical y todos tratados de forma conservadora. La mortalidad postoperatoria fue del 7%.
En nuestra serie, la incidencia de dehiscencia anastomótica en pacientes sometidos a gastroplastia con anastomosis cervical tras acondicionamiento isquémico angiográfico es del 7%. El acondicionamiento isquémico angiográfico es un procedimiento con una morbilidad aceptable.
Oesophageal reconstruction by gastroplasty with cervical anastomosis has a higher incidence of dehiscence. The aim of the study is to analyse the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischaemic conditioning of the gastric conduit.
Prospective analysis of patients who underwent gastric conditioning two weeks prior to oesophageal reconstruction, from January 2001 to January 2014.
The conditioning was performed by angiographic embolization of the left and right gastric artery, and splenic artery.
The main variable analysed was the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis.
Secondary variables analysed were the result of the conditioning, complications arising from that procedure and in the postoperative period, and mean length of postconditioning and postoperative hospital stay.
Gastric conditioning was indicated in 97 patients, with neoplasia being the most frequent aetiology motivating the oesophageal reconstruction (76%). 96 procedures were successfully carried out, arterial embolization was complete in 80 (83%). The morbidity rate was 13%, with no mortality. Postoperative morbidity was 45%; the most frequent complications associated with the surgery were respiratory problems. Six (7%) patients experienced cervical fistula, and all received conservative treatment. The rate of postoperative mortality was 7%.
In our serie the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischaemic conditioning is 7%.
Angiographic ischaemic conditioning is a procedure with acceptable morbidity
Ischemic Conditioning of the Stomach in the Prevention of Esophagogastric Anastomotic Leakage after Esophagectomy
2016, Annals of Thoracic Surgery
Citation Excerpt :
The left gastric artery is embolized with coils as a standard procedure. Additionally, occlusion of the splenic artery at its root, of the origin of the short gastric arteries, and of the right gastric artery have been described [29–33]. The position of coils and the efficacy of embolization are verified by angiography at the end of the procedure.
Esophagectomy with esophagogastric anastomosis is a major procedure, and its most feared complication is anastomotic leakage. Ischemic conditioning of the stomach is a method used with the aim of reducing the risk of leakage. It consists of partial gastric devascularization through embolization or laparoscopy followed by esophagectomy and anastomosis at a second stage, thus providing the time for the gastric conduit to adapt to the acute ischemia at the time of its formation. This review analyzes the information from all currently available experimental and clinical studies with the purpose of assessing the current role of the technique and to provide future recommendations.
Management of Conduit Necrosis Following Esophagectomy
2015, Thoracic Surgery Clinics

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Preoperative embolization of gastric arteries for esophageal cancer

Atrophic chronic gastritis and esophagogastric anastomotic leak after resection and reconstruction for esophageal carcinoma

J Surg Oncol

Marked and prolonged depression of factor XIII after esophageal resection

Surgery Today

Cancer of the esophagus: esophagogastric anastomotic leak. A retrospective study of predisposing factors

J Surg Oncol

Correlations between preoperative malnutrition and septic complications of esophageal cancer surgery

Nutrition

Experimental and clinical studies on the viability of stomach roll for esophageal reconstruction

J Jpn Surg Society