Perfusion of the gastric conduit during esophagectomy

Linder, Gustav; Hedberg, Jakob; Björck, Martin; Sundbom, Magnus

doi:10.1111/dote.12537

Cited by 15 publications

(9 citation statements)

References 27 publications

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“…Additionally, ischaemia can progress to gastric conduit necrosis (CN), which may result in severe sepsis and death if appropriate interventions are not performed[1]. More minor forms may result in poor perfusion to the gastric tube, particularly the most cranial part, which is used to create the anastomosis[6]. It has been hypothesised that calcification of the arteries supplying the gastric tube, a surrogate marker for atherosclerosis, may contribute to tissue ischaemia and hence be linked to AL and CN.…”

Section: Introductionmentioning

confidence: 99%

Vascular calcification does not predict anastomotic leak or conduit necrosis following oesophagectomy

Jefferies

Evans

Bundred

et al. 2019

WJGS

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BACKGROUNDAnastomotic leaks (AL) and gastric conduit necrosis (CN) are serious complications following oesophagectomy. Some studies have suggested that vascular calcification may be associated with an increased AL rate, but this has not been validated in a United Kingdom population.AIMTo investigate whether vascular calcification identified on the pre-operative computed tomography (CT) scan is predictive of AL or CN.METHODSRoutine pre-operative CT scans of 414 patients who underwent oesophagectomy for malignancy with oesophagogastric anastomosis at the Queen Elizabeth Hospital Birmingham between 2006 and 2018 were retrospectively analysed. Calcification of the proximal aorta, distal aorta, coeliac trunk and branches of the coeliac trunk was scored by two reviewers. The relationship between these calcification scores and occurrence of AL and CN was then analysed. The Esophagectomy Complications Consensus Group definition of AL and CN was used.RESULTSComplication data were available in n = 411 patients, of whom 16.7% developed either AL (15.8%) or CN (3.4%). Rates of AL were significantly higher in female patients, at 23.0%, compared to 13.9% in males (P = 0.047). CN was significantly more common in females, (8.0% vs 2.2%, P = 0.014), patients with diabetes (10.6% vs 2.5%, P = 0.014), a history of smoking (10.3% vs 2.3%, P = 0.008), and a higher American Society of Anaesthesiologists grade (P = 0.024). Out of the 14 conduit necroses, only 4 occurred without a concomitant AL. No statistically significant association was found between calcification of any of the vessels studied and either of these outcomes. Multivariable analyses were then performed to identify whether a combination of the calcification scores could be identified that would be significantly predictive of any of the outcomes. However, the stepwise approach did not select any factors for inclusion in the final models. The analysis was repeated for composite outcomes of those patients with either AL or CN (n = 69, 16.7%) and for those with both AL and CN (n = 10, 2.4%) and again, no significant associations were detected. In the subset of patients that developed these outcomes, no significant associations were detected between calcification and the severity of the complication.CONCLUSIONCalcification scoring was not significantly associated with Anastomotic Leak or CN in our study, therefore should not be used to identify patients who are high risk for these complications.

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Section: Introductionmentioning

confidence: 99%

Vascular calcification does not predict anastomotic leak or conduit necrosis following oesophagectomy

Jefferies

Evans

Bundred

et al. 2019

WJGS

View full text Add to dashboard Cite

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“…39 The gastric tube, which is part of the esophageal anastomosis, is exclusively supplied by the right gastric and gastroepiploic arteries and therefore is prone to impaired perfusion. 40,41 In colorectal surgery, however, similar outcomes could not be con-…”

Section: Discussionmentioning

confidence: 99%

Calcification of the Aorta-Iliac Trajectory as a Risk Factor for Anastomotic Leakage in Colorectal Surgery: Individual Patient Data Meta-Analysis and Systematic Review

Edomskis

Menon

et al. 2021

Surg Technol Int.

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Objective: The purpose of this review is to evaluate the relevance of vascular calcification as a potential risk factor for anastomotic leakage in colorectal surgery. Method: The Embase, Medline, PubMed, and Cochrane databases and Google Scholar were systematically searched. Studies that assessed calcification of the aorta-iliac trajectory in patients who underwent colorectal surgery were included. An independent patient data meta-analysis was performed as follows: based on the heterogeneity of the study population, a “random-effects model” or “fixed-effects model” was used to perform a multivariable logistic regression and calculate pooled Odds Ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the Q-test and I2-test. Results: From a total of 457 articles retrieved, eight fell within the scope of the review, with a total of 2010 patients. Anastomotic leakage was found at a mean rate of 11.1% (SD 4.9%). In these eight studies, four different calcification scoring methods were used, which made a single structured meta-analysis not feasible. Therefore, an independent patient data meta-analysis on the most frequently used calcification scoring method was performed, including three studies with a total of 396 patients. After multivariable analyses, no significant association was found between anastomotic leakage and the amount of calcification in the aorta-iliac trajectory. The remaining three scoring methods were evaluated. In four of the five studies, vascular calcification was associated with anastomotic leakage after colorectal surgery. Conclusion: In contrast to previous studies, an individual patient data meta-analysis found no association between calcification and anastomotic leakage in colorectal surgery after multivariable analysis that considered a single calcification measurement method. In addition, this study demonstrated several scoring methods for arterial calcification and the need for a standardized technique. Therefore, the authors would recommend prospective studies using a calcification scoring method that includes grade of stenosis due to its potential to preoperatively improve perfusion by endovascular treatment.

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“…Both are surgeon-dependent, and more reproducible objective methods for evaluation of graft viability are necessary. In the literature review by Jansen et al, [35][36][37][38][39] several methods were examined, such as laser speckle contrast imaging, gastric tonometry, Doppler flowmetry, spectroscopy, infrared thermographic imaging, optical coherence tomography, and angiography. None of these approaches have been widely accepted in routine practice, mainly because of low reproducibility.…”

Section: Angiography Of Blood Supply Of Different Organsmentioning

confidence: 99%

Near-Infrared Fluorescence Image-Guided Surgery in Esophageal and Gastric Cancer Operations

et al. 2022

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Background Near-infrared fluorescence image-guided surgery helps surgeons to see beyond the classical eye vision. Over the last few years, we have witnessed a revolution which has begun in the field of image-guided surgery. Purpose, and Research design Fluorescence technology using indocyanine green (ICG) has shown promising results in many organs, and in this review article, we wanted to discuss the 6 main domains where fluorescence image-guided surgery is currently used for esophageal and gastric cancer surgery. Study sample and data collection Visualization of lymphatic vessels, tumor localization, fluorescence angiography for anastomotic evaluation, thoracic duct visualization, tracheal blood flow analysis, and sentinel node biopsy are discussed. Conclusions It seems that this technology has already found its place in surgery. However, new possibilities and research avenues in this area will probably make it even more important in the near future.

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Perfusion of the gastric conduit during esophagectomy

Cited by 15 publications

References 27 publications

Vascular calcification does not predict anastomotic leak or conduit necrosis following oesophagectomy

Vascular calcification does not predict anastomotic leak or conduit necrosis following oesophagectomy

Calcification of the Aorta-Iliac Trajectory as a Risk Factor for Anastomotic Leakage in Colorectal Surgery: Individual Patient Data Meta-Analysis and Systematic Review

Near-Infrared Fluorescence Image-Guided Surgery in Esophageal and Gastric Cancer Operations

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