Laparoscopic ischaemic conditioning of the stomach may reduce gastric-conduit morbidity following total minimally invasive oesophagectomy☆

Abstract

In this non-randomised clinical setting, our results suggest that ischaemic conditioning of the stomach prior to MIO is safe. There is a trend to reduced morbidity related to gastric-conduit ischaemia, which was demonstrated by a CUSUM analysis. A randomised trial is needed before ligation of the left gastric artery can be routinely recommended.

Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy

“…Our initial series of ligation 2 weeks preoperatively resulted in an apparent reduction of ischemic complications, as analyzed by Cumulative Sum (CUSUM) [29]. However we had some concerns about adhesions at definitive surgery (Fig.…”

Randomized controlled trial of laparoscopic gastric ischemic conditioning prior to minimally invasive esophagectomy, the LOGIC trial

“…Akiyama in 1992 [27] reported the first human clinical series, and more recent studies have confirmed a beneficial impact of conditioning [28][29][30][31][32][33][34]. We adopted the practice, and in our own series have reported a decrease in the incidence of GCF [35]. Two weeks seems to be the optimal timing for ischemic conditioning [36].…”

Minimally invasive esophagectomy with two-field lymphadenectomy

“…As a consequence, we adopted two technical modifications aimed at reducing gastric conduit failure: (1) ischemic conditioning of the stomach by ligation of the left gastric artery 2 weeks before esophagectomy [5,6] and (2) use of a hand port to exteriorize the stomach and fashion an extracorporeal conduit. These key modifications (Fig.…”