Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience

Journal Article · Mon May 15 04:00:00 EDT 2017 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-016-1556-2· OSTI ID:22645222

Ghelfi, Julien ^[1]; Brichon, Pierre-Yves ^[2]; Frandon, Julien ^[3]; Boussat, Bastien ^[4]; Bricault, Ivan; Ferretti, Gilbert ^[1]; Guigard, Sébastien ^[2]; Sengel, Christian ^[1]

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1. CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France)
2. CHU de Grenoble, Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne (France)
3. CHU de Nîmes, Clinique Universitaire de Radiologie et Imagerie Médicale (France)
4. CHU de Grenoble, Département d’Information Médicale, Pôle de Santé Publique (France)

PurposeSurgical esophagectomy is the gold standard treatment of early-stage esophageal cancer. The procedure is complicated with significant morbidity; the most severe complication being the anastomotic leakage. Anastomotic fistulas are reported in 5–25% of cases and are mainly due to gastric transplant ischemia. Here, we report our experience of ischemic pre-conditioning using preoperative arterial embolization (PreopAE) before esophagectomy.Materials and MethodsThe medical records of all patients who underwent oncologic esophagectomy from 2008 to 2015 were retrospectively reviewed. Patients were divided into two groups: patients who received PreopAE, and a control group of patients who did not benefit from ischemic pre-conditioning. The target arteries selected for PreopAE were the splenic artery, left gastric artery, and right gastric artery. Evaluation of the results was based on anastomotic leakage, postoperative mortality, technical success of PreopAE, and complications related to the embolization procedure.ResultsForty-six patients underwent oncologic esophagectomy with PreopAE and 13 patients did not receive ischemic conditioning before surgery. Thirty-eight PreopAE were successfully performed (83%), but right gastric artery embolization failed for 8 patients. Anastomotic leakage occurred in 6 PreopAE patients (13%) and in 6 patients (46%) in the control group (p = 0.02). The mortality rate was 2% in the PreopAE group and 23% in the control group (p = 0.03). Eighteen patients suffered from partial splenic infarction after PreopAE, all treated conservatively.ConclusionPreoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage.

• OSTI ID: 22645222
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 5 Vol. 40; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ARTERIES
DISEASE INCIDENCE
ESOPHAGUS
EVALUATION
ISCHEMIA
MEDICAL RECORDS
MORTALITY
NEOPLASMS
PATIENTS
REVIEWS
SURGERY
TRANSPLANTS