Grenoble Alpes University Hospital Grenoble Alpes University Grenoble, Rhone-Alpes, France
Background: Surgery is the standard of care of early stage esophageal and colorectal cancers. One of the dreaded complications is anastomotic leakage whose main risk factor is ischemia of the anastomosis secondary to vascular ligation (gastric short vessels and left gastric artery for esophagectomy and inferior mesenteric artery for left colic/rectal surgery).
Purpose/Objective: To evaluate the feasibility, safety and effectiveness of preoperative ischemic conditioning by embolization before esophagectomy or colorectal surgery.
Materials & Methods: All patients treated by embolization before esophageal or left colic/rectal surgery between 2010 and 2022 in our center were retrospectively included. The targeted arteries were the splenic, left gastric and right gastric arteries for esophageal conditioning and the proximal inferior mesenteric artery for colorectal conditioning.
Results: 91 patients were included, 80 patients (88%) before esophageal surgery and 11 patients (12%) before colorectal surgery. For esophageal conditioning, 68 patients (85%) had complete embolization (3 targeted arteries) and 11 patients (14%) had a postoperative fistula. No transplant necrosis was reported and the 90-day mortality was 6%, including 3 patients (60%) with fistula. Fifteen patients (19%) had transient post embolization pain, 1 patient (1%) had hepatic artery thrombosis. Regarding colorectal conditioning, embolization was achieved in 11 patients (100%). The maximum diameter of the Riolan’s arcade on CT scan increased from a median of 1.4 mm [IQR: 1.2-1.6] preoperatively to 2.3 mm [IQR: 2.1-2.4] at 3 weeks after embolization (p=0.005). Three patients (27%) had transient abdominal pain after embolization, 1 patient (9%) had an anastomotic leakage following surgery and 1 patient died secondary to respiratory distress without anastomotic abnormality after surgery.
Conclusion: Preoperative ischemic conditioning is feasible and safe. It decreases the risk of transplant necrosis for esophageal surgery and develops the Riolan’s arcade for colorectal surgery.
