Laparoscopic ischemic conditioning prior esophagectomy in selected patients: the ISCON trial.

Abstract

Anastomotic leakage (AL) after esophagectomy is the most impactful complication after esophagectomy. Ischemic conditioning (ISCON) of the stomach >14 days prior to esophagectomy might reduce the incidence of AL. The current trial was conducted to prospectively investigate the safety and feasibility of laparoscopic ISCON in selected patients. This international multicenter feasibility trial included patients with esophageal cancer at high risk for AL with major calcifications of the thoracic aorta or a stenosis in the celiac trunk. Patients underwent laparoscopic ISCON by occlusion of the left gastric and the short gastric arteries followed by esophagectomy after an interval of 12-18 days. The primary endpoint was complications Clavien-Dindo ≥ grade 2 after ISCON and before esophagectomy. Between November 2019 and January 2022, 20 patients underwent laparoscopic ISCON followed by esophagectomy. Out of 20, 16 patients (80%) underwent neoadjuvant treatment. The median duration of the laparoscopic ISCON procedure was 45 minutes (range: 25-230). None of the patients developed intraoperative or postoperative complications after ISCON. Hospital stay after ISCON was median 2 days (range: 2-4 days). Esophagectomy was completed in all patients after a median of 14 days (range: 12-28). AL occurred in three patients (15%), and gastric tube necrosis occurred in one patient (5%). In hospital, the 30-day and 90-day mortalities were 0%. Laparoscopic ISCON of the gastric conduit is feasible and safe in selected esophageal cancer patients with an impaired vascular status. Further studies have to prove whether this innovative strategy aids to reduce the incidence of AL.

• Authors: Eline de Groot, Lars M Schiffmann, Arjen van der Veen, Alicia Borggreve, Pim de Jong, Daniel Pinto Dos Santos, Benjamin Babic, Hans Fuchs, Jelle Ruurda, Christiane Bruns, Richard van Hillegersberg, Wolfgang Schröder
• Journal: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (Dis Esophagus) Vol. 36 Issue 11 (Oct 27 2023) ISSN: 1442-2050 [Electronic] United States
• PMID: 37151103 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: [email protected].

Topics

• Humans
• Anastomosis, Surgical (adverse effects)
• Anastomotic Leak (epidemiology, etiology, surgery)
• Esophageal Neoplasms (complications)
• Esophagectomy (adverse effects, methods)
• Laparoscopy (adverse effects)
• Postoperative Complications (epidemiology, etiology, surgery)
• Retrospective Studies
• Stomach (surgery, blood supply)
• Feasibility Studies