A Novel Technique to Improve Anastomotic Perfusion Prior to Esophageal Surgery: Hybrid Ischemic Preconditioning of the Stomach. Preclinical Efficacy Proof in a Porcine Survival Model.

Date publication

octobre 2020

Journal

Cancers

Auteurs

Membres identifiés du Cancéropôle Est :
Dr LINDNER Véronique , Pr MARESCAUX Jacques , Pr GENY Bernard

Tous les auteurs :
Barberio M, Felli E, Pop R, Pizzicannella M, Geny B, Lindner V, Baiocchini A, Jansen-Winkeln B, Moulla Y, Agnus V, Marescaux J, Gockel I, Diana M

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/33066529

Résumé

Esophagectomy often presents anastomotic leaks (AL), due to tenuous perfusion of gastric conduit fundus (GCF). Hybrid (endovascular/surgical) ischemic gastric preconditioning (IGP), might improve GCF perfusion. Sixteen pigs undergoing IGP were randomized: (1) Max-IGP ( = 6): embolization of left gastric artery (LGA), right gastric artery (RGA), left gastroepiploic artery (LGEA), and laparoscopic division (LapD) of short gastric arteries (SGA); (2) Min-IGP ( = 5): LGA-embolization, SGA-LapD; (3) Sham ( = 5): angiography, laparoscopy. At day 21 gastric tubulation occurred and GCF perfusion was assessed as: (A) Serosal-tissue-oxygenation (StO) by hyperspectral-imaging; (B) Serosal time-to-peak (TTP) by fluorescence-imaging; (C) Mucosal functional-capillary-density-area (FCD-A) index by confocal-laser-endomicroscopy. Local capillary lactates (LCL) were sampled. Neovascularization was assessed (histology/immunohistochemistry). Sham presented lower StO and FCD-A index (41 ± 10.6%; 0.03 ± 0.03 respectively) than min-IGP (66.2 ± 10.2%, -value = 0.004; 0.22 ± 0.02, -value < 0.0001 respectively) and max-IGP (63.8 ± 9.4%, -value = 0.006; 0.2 ± 0.02, -value < 0.0001 respectively). Sham had higher LCL (9.6 ± 4.8 mL/mol) than min-IGP (4 ± 3.1, -value = 0.04) and max-IGP (3.4 ± 1.5, -value = 0.02). For StO, FCD-A, LCL, max- and min-IGP did not differ. Sham had higher TTP (24.4 ± 4.9 s) than max-IGP (10 ± 1.5 s, -value = 0.0008) and min-IGP (14 ± 1.7 s, non-significant). Max- and min-IGP did not differ. Neovascularization was confirmed in both IGP groups. Hybrid IGP improves GCF perfusion, potentially reducing post-esophagectomy AL.

Mots clés

Ivor-Lewis procedure, anastomotic leak, confocal laser endomicroscopy, esophageal cancer, esophageal resection, fluorescence imaging, hyperspectral imaging, ischemic preconditioning, optical imaging

Référence

Cancers (Basel). 2020 Oct 14;12(10):