Gastric Conditioning Before Ivor Lewis Esophagectomy for Cancer: Long-Term Outcomes From the APIL_2013 Pilot...

Area of Science:

• Oncology
• Gastroenterology
• Surgical Innovation

Background:

• Gastric ischemic conditioning (GIC) is linked to better short-term results in Ivor Lewis esophagectomy for cancer.
• GIC may reduce anastomotic leakage (AL) incidence and severity.
• The long-term impact of GIC on esophageal surgery outcomes requires investigation.

Purpose of the Study:

• To evaluate the long-term effects of GIC on outcomes following esophageal surgery.
• To compare GIC with surgery alone (SA) in a randomized pilot trial.

Main Methods:

• A randomized, single-center, controlled, parallel-group pilot trial was conducted.
• Two groups were compared: GIC before Ivor Lewis esophagectomy versus SA.
• Primary endpoint: anastomotic stricture; Secondary endpoints: oral intake, reconstructive surgery, chronic AL, airway fistulation, mortality, overall survival (OS), and recurrence rates at 1, 3, and 5 years.

Main Results:

• No anastomotic strictures were observed in either group.
• Oral intake success rates were 90% (GIC) vs. 72.2% (SA) (P=0.222).
• Overall survival (55% vs. 36%) and disease-free survival (50% vs. 36.8%) were comparable, as were recurrence rates. Patients without gastric conduit failure had significantly better survival (P=0.018).

Conclusions:

• Long-term outcomes including anastomotic stricture, chronic AL, survival, and recurrence rates were similar between GIC and SA groups.
• Gastric conduit failure negatively impacts overall survival after esophageal surgery.
• GIC does not appear to significantly alter long-term survival or recurrence rates but avoiding conduit failure is crucial.