Thai H Pham1, Shelby D Melton2, Patrick J McLaren3, Ali A Mokdad1, Sergio Huerta1, David H Wang4, Kyle A Perry5, Hope L Hardaker3, James P Dolan3. 1. Surgical Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas. 2. Pathology Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas. 3. Division of Gastrointestinal and General Surgery and the Digestive Health Center, Department of Surgery, Oregon Health & Science University Medical Center, Portland, Oregon. 4. Hematology Oncology, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas. 5. Department of Surgery, Ohio State University Medical Center, Columbus, Ohio.
Abstract
BACKGROUND AND OBJECTIVES: Gastric ischemic preconditioning has been proposed to improve blood flow and reduce the incidence of anastomotic complications following esophagectomy with gastric pull-up. This study aimed to evaluate the effect of prolonged ischemic preconditioning on the degree of neovascularization in the distal gastric conduit at the time of esophagectomy. METHODS: A retrospective review of a prospectively maintained database identified 30 patients who underwent esophagectomy. The patients were divided into three groups: control (no preconditioning, n = 9), partial (short gastric vessel ligation only, n = 8), and complete ischemic preconditioning (left and short gastric vessel ligation, n = 13). Microvessel counts were assessed, using immunohistologic analysis to determine the degree of neovascularization at the distal gastric margin. RESULTS: The groups did not differ in age, gender, BMI, pathologic stage, or cancer subtype. Ischemic preconditioning durations were 163 ± 156 days for partial ischemic preconditioning, compared to 95 ± 50 days for complete ischemic preconditioning (P = 0.2). Immunohistologic analysis demonstrated an increase in microvessel counts of 29% following partial ischemic preconditioning (P = 0.3) and 67% after complete ischemic preconditioning (P < 0.0001), compared to controls. CONCLUSIONS: Our study indicates that prolonged ischemic preconditioning is safe and does not interfere with subsequent esophagectomy. Complete ischemic preconditioning increased neovascularization in the distal gastric conduit.
BACKGROUND AND OBJECTIVES:Gastric ischemic preconditioning has been proposed to improve blood flow and reduce the incidence of anastomotic complications following esophagectomy with gastric pull-up. This study aimed to evaluate the effect of prolonged ischemic preconditioning on the degree of neovascularization in the distal gastric conduit at the time of esophagectomy. METHODS: A retrospective review of a prospectively maintained database identified 30 patients who underwent esophagectomy. The patients were divided into three groups: control (no preconditioning, n = 9), partial (short gastric vessel ligation only, n = 8), and complete ischemic preconditioning (left and short gastric vessel ligation, n = 13). Microvessel counts were assessed, using immunohistologic analysis to determine the degree of neovascularization at the distal gastric margin. RESULTS: The groups did not differ in age, gender, BMI, pathologic stage, or cancer subtype. Ischemic preconditioning durations were 163 ± 156 days for partial ischemic preconditioning, compared to 95 ± 50 days for complete ischemic preconditioning (P = 0.2). Immunohistologic analysis demonstrated an increase in microvessel counts of 29% following partial ischemic preconditioning (P = 0.3) and 67% after complete ischemic preconditioning (P < 0.0001), compared to controls. CONCLUSIONS: Our study indicates that prolonged ischemic preconditioning is safe and does not interfere with subsequent esophagectomy. Complete ischemic preconditioning increased neovascularization in the distal gastric conduit.
Authors: John W Briel; Anand P Tamhankar; Jeffrey A Hagen; Steven R DeMeester; Jan Johansson; Emmanouel Choustoulakis; Jeffrey H Peters; Cedric G Bremner; Tom R DeMeester Journal: J Am Coll Surg Date: 2004-04 Impact factor: 6.113
Authors: James D Luketich; Miguel Alvelo-Rivera; Percival O Buenaventura; Neil A Christie; James S McCaughan; Virginia R Litle; Philip R Schauer; John M Close; Hiran C Fernando Journal: Ann Surg Date: 2003-10 Impact factor: 12.969
Authors: Steve R Siegal; Abhishek D Parmar; Kelly R Haisley; Brandon H Tieu; Paul H Schipper; John G Hunter; James P Dolan Journal: J Gastrointest Surg Date: 2018-05-29 Impact factor: 3.452
Authors: Wei Zhang; Ankur S Bhagwath; Zeeshan Ramzan; Taylor A Williams; Indhumathy Subramaniyan; Vindhya Edpuganti; Raja Reddy Kallem; Kerry B Dunbar; Peiguo Ding; Ke Gong; Samuel A Geurkink; Muhammad S Beg; James Kim; Qiuyang Zhang; Amyn A Habib; Sung-Hee Choi; Ritu Lapsiwala; Gayathri Bhagwath; Jonathan E Dowell; Shelby D Melton; Chunfa Jie; William C Putnam; Thai H Pham; David H Wang Journal: Mol Cancer Ther Date: 2021-08-10 Impact factor: 6.261