title: Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience.
abstract: OBJECTIVE
  Surgical esophagectomy is the gold standard treatment of early-stage esophageal cancer. The procedure is complicated with significant morbidity; the most severe complication being the anastomotic leakage. Anastomotic fistulas are reported in 5-25% of cases and are mainly due to gastric transplant ischemia. Here, we report our experience of ischemic pre-conditioning using preoperative arterial embolization (PreopAE) before esophagectomy.
  
  
  METHODS
  The medical records of all patients who underwent oncologic esophagectomy from 2008 to 2015 were retrospectively reviewed. Patients were divided into two groups: patients who received PreopAE, and a control group of patients who did not benefit from ischemic pre-conditioning. The target arteries selected for PreopAE were the splenic artery, left gastric artery, and right gastric artery. Evaluation of the results was based on anastomotic leakage, postoperative mortality, technical success of PreopAE, and complications related to the embolization procedure.
  
  
  RESULTS
  Forty-six patients underwent oncologic esophagectomy with PreopAE and 13 patients did not receive ischemic conditioning before surgery. Thirty-eight PreopAE were successfully performed (83%), but right gastric artery embolization failed for 8 patients. Anastomotic leakage occurred in 6 PreopAE patients (13%) and in 6 patients (46%) in the control group (p = 0.02). The mortality rate was 2% in the PreopAE group and 23% in the control group (p = 0.03). Eighteen patients suffered from partial splenic infarction after PreopAE, all treated conservatively.
  
  
  CONCLUSIONS
  Preoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage.
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France. JGhelfi@chu-grenoble.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Ghelfi
authors.affiliation: Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Brichon
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Nîmes, 30029, Nîmes Cedex 09, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Frandon
authors.affiliation: Département d'Information Médicale, Pôle de Santé Publique, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Boussat
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Bricault
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ferretti
authors.affiliation: Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Guigard
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Sengel
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000517:prevention & control*; D004621:Embolization, Therapeutic / Q000379:methods*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply*; D016896:Treatment Outcome
keywords: Anastomotic leakage; Embolization; Esophagectomy; Gastric artery; Ischemic conditioning