• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

Laparoscopic Gastric Ischemic Conditioning Prior to Minimally Invasive Esophagectomy, the Logic Trial

DARMARAJAH VEERAMOOTOO, MB BS MRCS MD, ANGELA C SHORE, PhD, SHAHJEHAN A WAJED, MA BM BCh MChir FRCS. Department of Upper Gastro-Intestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. Institute of Biomedical and Clinical Sciences, University of Exeter, Exeter, United Kingdom.

Introduction:
Minimally invasive esophagectomy (MIE) is recognised as a valid, less traumatic alternative to open surgery for the management of resectable esophago-gastric cancer. However, a significant incidence of ischemia-related gastric conduit failure (GCF) is observed with this approach. Laparoscopic Ischemic conditioning (LIC) of the stomach by ligation of the left gastric vessels two weeks prior to MIE, through a potential improvement of conduit perfusion, is believed to have a protective role. The purpose of this project was therefore to evaluate whether ischemic conditioning improved eventual conduit perfusion.

Methods:
A randomised controlled trial was designed to compare MIE with LIC at two weeks (Lig) against MIE without LIC (Non-lig). The MIE technique is a three-stage procedure consisting of a thoracoscopic phase, laparoscopy and extra-corporeal fashioning of the gastric conduit and finally a cervical anastomosis. This ethically-approved project began in May 2009 and was offered to all consecutive consenting patients. A multifactorial analysis of variance allowed block randomisation of subjects into the two trial arms. The main outcome measure was perfusion recorded from the serosal surface of the stomach by validated laser Doppler fluximetry. Areas of interest were the fundus (F) and greater curve (GC) and measurements were carried out at routine staging laparoscopy before and after intervention and again at every stage of an MIE (Laparoscopy = baseline, exteriorisation of stomach, conduit formation and delivery at neck). Mean perfusion values were compared using Wilcoxon matched pairs test; and a perfusion coefficient measured as a ratio at stage of MIE over baseline was used for statistical analysis (Mann Whitney U-test).

Results:
16 patients were recruited prior to an interim analysis of the trial data, 8 in each arm. At staging laparoscopy perfusion at F was higher than at GC (603.3±153.0 v 543.9±167.6; p=0.016). In the Lig cohort an apparent rise in perfusion at GC is observed post intervention (538.0±174.0 v 496.8±184.5, p=0.176). At MIO, baseline perfusion is comparable for both arms; F being higher than GC but a significant drop is noted once stomach is mobilised and exteriorised (F: Lap. 539.7±161.6 v outside 207.5±73.7, p=0.0001 and GC: Lap. 489.3±112.8 v outside 323.4±92.3, p=0.001). Perfusion at GC is now higher than F (p=0.001). This trend is repeated at the conduit stage. Once delivered at the neck, perfusion ratio of the conduit is about 38% of baseline (range=18.1 to 67.4). However there is no difference between the Lig (38.3±12.0) and Non-lig (37.7±16.8) cohorts (p=0.798).

Conclusions:
This study demonstrates the effect of stomach devascularisation is such that conduit perfusion is only around 1/3 of that present initially. The interim analysis revealed no effect of ischemic conditioning by ligation of the left gastric vessels on conduit perfusion. If the effects were as great as reported in historical series, a difference in perfusion would have been expected even at this interim analysis.


Session: SS08
Program Number: S038

93

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2011 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons