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

Abstract

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 controlmore » 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.« less

Authors:
 [1];  [2];  [3];  [4]; ;  [1];  [2];  [1]
  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)
Publication Date:
OSTI Identifier:
22645222
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 5; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; DISEASE INCIDENCE; ESOPHAGUS; EVALUATION; ISCHEMIA; MEDICAL RECORDS; MORTALITY; NEOPLASMS; PATIENTS; REVIEWS; SURGERY; TRANSPLANTS

Citation Formats

Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr, Brichon, Pierre-Yves, E-mail: PYBrichon@chu-grenoble.fr, Frandon, Julien, E-mail: Julien.frandon@chu-nimes.fr, Boussat, Bastien, E-mail: BBoussat@chu-grenoble.fr, Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr, Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr, Guigard, Sébastien, E-mail: SGuigard@chu-grenoble.fr, and Sengel, Christian, E-mail: CSengel@chu-grenoble.fr. Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience. United States: N. p., 2017. Web. doi:10.1007/S00270-016-1556-2.
Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr, Brichon, Pierre-Yves, E-mail: PYBrichon@chu-grenoble.fr, Frandon, Julien, E-mail: Julien.frandon@chu-nimes.fr, Boussat, Bastien, E-mail: BBoussat@chu-grenoble.fr, Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr, Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr, Guigard, Sébastien, E-mail: SGuigard@chu-grenoble.fr, & Sengel, Christian, E-mail: CSengel@chu-grenoble.fr. Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience. United States. doi:10.1007/S00270-016-1556-2.
Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr, Brichon, Pierre-Yves, E-mail: PYBrichon@chu-grenoble.fr, Frandon, Julien, E-mail: Julien.frandon@chu-nimes.fr, Boussat, Bastien, E-mail: BBoussat@chu-grenoble.fr, Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr, Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr, Guigard, Sébastien, E-mail: SGuigard@chu-grenoble.fr, and Sengel, Christian, E-mail: CSengel@chu-grenoble.fr. Mon . "Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience". United States. doi:10.1007/S00270-016-1556-2.
@article{osti_22645222,
title = {Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience},
author = {Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr and Brichon, Pierre-Yves, E-mail: PYBrichon@chu-grenoble.fr and Frandon, Julien, E-mail: Julien.frandon@chu-nimes.fr and Boussat, Bastien, E-mail: BBoussat@chu-grenoble.fr and Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr and Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr and Guigard, Sébastien, E-mail: SGuigard@chu-grenoble.fr and Sengel, Christian, E-mail: CSengel@chu-grenoble.fr},
abstractNote = {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.},
doi = {10.1007/S00270-016-1556-2},
journal = {Cardiovascular and Interventional Radiology},
number = 5,
volume = 40,
place = {United States},
year = {Mon May 15 00:00:00 EDT 2017},
month = {Mon May 15 00:00:00 EDT 2017}
}