title: Redistribution of gastric blood flow by embolization of gastric arteries before esophagectomy.
abstract: BACKGROUND
  Anastomotic leak remains a common and potentially deleterious complication after esophagectomy. Preoperative embolization of the left gastric artery and splenic artery (PAE) has been suggested to lower anastomotic leak rates. We present the results of our 5-year experience with this technique.
  
  
  METHODS
  All patients undergoing PAE before esophagectomy since introduction of this technique in 2004 were compared in a 1:2 matched-pair analysis with patients without PAE. Matching criteria were type of anastomosis, neoadjuvant treatment, comorbidity, and age. Data were derived from a retrospective chart review from 2000 to 2006 that was perpetuated as a prospective database up to date. Outcome measures were anastomotic leak, overall complications, and hospital stay.
  
  
  RESULTS
  Between 2000 and 2009, 102 patients underwent esophagectomy for cancer in our institution with an overall leak rate of 19% and a mortality of 8%. All 19 patients having PAE since 2004 were successfully matched 1:2 to 38 control patients without PAE; both groups were similar regarding demographics and operation characteristics. Two PAE (11%) and 8 control patients (21%) had an anastomotic leak, but the difference was statistically not significant (p=0.469). Overall and major complication rates for PAE and control group were 89% versus 79% (p=0.469) and 37% versus 34% (p=1.000), respectively. Median intensive care unit and hospital stay were 3 versus 3 days (p=1.000) and 22 versus 17 days (p=0.321), respectively.
  
  
  CONCLUSIONS
  In our experience, PAE has no significant impact on complications and anastomotic leak in particular after esophagectomy.
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.forename: Henri
authors.initials: H
authors.lastname: Vuilleumier
authors.forename: Pierre
authors.initials: P
authors.lastname: Bize
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000517:prevention & control*; D001783:Blood Flow Velocity; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013270:Stomach / Q000098:blood supply*; D016019:Survival Analysis; D016896:Treatment Outcome