After an Ivor Lewis esophagectomy, anastomotic leakage (AL) is highly morbid and lethal. One of the most crucial elements for anastomotic viability is blood perfusion of the gastroplasty, which is improved by preoperative gastric conditioning (GC). For a study, researchers sought to assess if patients who needed an Ivor Lewis esophagectomy and had esophageal cancer or Siewert I-II esophagogastric junction cancer may benefit from GC before esophageal surgery.
It was a pilot clinical trial that was randomized (1:1), open-label, controlled, parallel-group, and conducted at a single center. Two research teams: Surgery alone (SA)-group: patients who received just an Ivor Lewis esophagectomy; GC-group: patients who underwent an Ivor Lewis esophagectomy and GC prior to surgery. The number of patients in whom a GC was conducted and the cumulative incidence of postoperative AL were used to evaluate feasibility. Conduit necrosis (CN), hospital stay, morbidity, death, and anastomotic stricture were considered secondary goals.
Twenty patients were randomly assigned to the GC group between 2015 and 2018 whereas 18 individuals were assigned to the SA group. About 17 GCs (85%) were successfully completed; 3 patients’ attempts to block the right gastric artery failed. Five out of 22 patients (all Clavien-Dindo ≤IIIa) had morbidity following GC. In both the GC-group and the SA-group, the cumulative incidence of AL was 15.0% (3/20, 95%CI: 5.2-36.0%) and 33.3% (6/18, 95% CI: 16.3-56.3%), respectively P-value: 0.184. Hospital stay (median [range] days): 12 [9-45] vs. 27.5 [10-166] (P-value: 0.067) days; CN: 0/20 vs. 1/18 (P-value: 0.474); surgical morbidity (Clavien-Dindo III-V): 7/20 vs. 12/18 (P-value: 0.070). When the analysis was limited to successful GCs (3 arteries), the GC group (P-value: 0.041) had a decreased rate of ischemia-related gastric conduit failure (AL and CN).
It appeared that preoperative arteriographic GC, performed before an Ivor Lewis esophagectomy, may lessen AL in patients with esophageal cancer or Siewert I-II esophagogastric junction cancer.
Reference: sciencedirect.com/science/article/pii/S1743919122006987
