Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer

Thai H. Pham, Shelby D. Melton, Patrick J. McLaren, Ali A. Mokdad, Sergio Huerta, David H. Wang, Kyle A. Perry, Hope L. Hardaker, James P. Dolan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)391-397
Number of pages7
JournalJournal of Surgical Oncology
Volume116
Issue number3
DOIs
StatePublished - Sep 1 2017

Fingerprint

Ischemic Preconditioning
Esophagectomy
Stomach
Neoplasms
Microvessels
Ligation
Databases

Keywords

  • anastomosis
  • esophageal cancer
  • esophagectomy
  • preconditioning

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer. / Pham, Thai H.; Melton, Shelby D.; McLaren, Patrick J.; Mokdad, Ali A.; Huerta, Sergio; Wang, David H.; Perry, Kyle A.; Hardaker, Hope L.; Dolan, James P.

In: Journal of Surgical Oncology, Vol. 116, No. 3, 01.09.2017, p. 391-397.

Research output: Contribution to journalArticle

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AU - Huerta, Sergio

AU - Wang, David H.

AU - Perry, Kyle A.

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AU - Dolan, James P.

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