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

Autor: Pham TH; Surgical Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas., Melton SD; Pathology Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas., McLaren PJ; Division of Gastrointestinal and General Surgery and the Digestive Health Center, Department of Surgery, Oregon Health & Science University Medical Center, Portland, Oregon., Mokdad AA; Surgical Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas., Huerta S; Surgical Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas., Wang DH; Hematology Oncology, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas., Perry KA; Department of Surgery, Ohio State University Medical Center, Columbus, Ohio., Hardaker HL; Division of Gastrointestinal and General Surgery and the Digestive Health Center, Department of Surgery, Oregon Health & Science University Medical Center, Portland, Oregon., Dolan JP; Division of Gastrointestinal and General Surgery and the Digestive Health Center, Department of Surgery, Oregon Health & Science University Medical Center, Portland, Oregon.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2017 Sep; Vol. 116 (3), pp. 391-397. Date of Electronic Publication: 2017 May 29.
DOI: 10.1002/jso.24668
Abstrakt: 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.
(© 2017 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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