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Optimizing ischemic preconditioning for esophagogastric anastomosis: A standardized rat model to evaluate histological changes


Authors: I. Kovac 1;  Z. Hribíková 2;  M. Miklosova 1;  K. Kovacova 2;  J. Gajdos 2;  D. Matiova 3;  D. Petrasova 3;  J. Belák 1
Authors‘ workplace: Department of Pathology, Louis Pasteur University Hospital and Pavol Jozef Safarik University, Kosice, Slovak Republic 2;  Laboratory of Research Bio-models, Pavol Jozef Safarik University, Kosice, Slovak Republic 3;  nd Department of Surgery, Louis Pasteur University Hospital and Pavol Jozef Safarik University, Kosice, Slovak Republic 12
Published in: Rozhl. Chir., 2024, roč. 103, č. 3, s. 84-90.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2024.103.3.84–90

Overview

Introduction: Na experimentálnu verifikáciu vitality žalúdočného tubulu pred ezofagektómiou je nevyhnutná existencia jednoduchého modelu. Ischémia je hlavná príčina dehiscencie ezofagogastrickej anastomózy a následného leaku anastomózy. Ischemická príprava žalúdočného tubulu pred ezofagektómiou je potencionálna možnosť ako zamedziť rozvoju nežiaducich komplikácií. Avšak technika ako aj optimálne načasovanie ischemizácie ostávajú nejasné.

Metody: Samce potkanov plemena Sprague-Dawley (n=24) boli náhodne rozdelené do štyroch skupín: ischemická skupina s odberom vzoriek po 1 hodine od ischémie (I1H), ischemická skupina s odberom vzoriek 1 deň od ischémie (I1D), ischemická skupina s odberom vzoriek 7 dní od ischémie (I7D) a kontrolná skupina (C). Ischémia bola navodená ligáciou a. gastrica sinistra a aa. gastricae breves. Vzorky boli histologicky a makroskopicky verifikované a stanovený bol počet a percentuálne zastúpenie jednotlivých imunokompetentných buniek.

Výsledky: V skupine I1H bola pozorovaná ischemická denudácia s mukozálnymi eróziami a celkový počet eozinofilov bol signifikantne vyšší (p<0.05) v tejto skupine v porovnaní so skupinami I1D a I7D. V skupine I1D bola pozorovaná redukcia zápalu a parciálna regenerácia žalúdočnej mukózy. V skupine I7D bola pozorovaná takmer kompletná architektonická regenerácia žalúdočného epitelu a počet polymorfonukleárov bol signifikantne nižší (p<0,05) ako v skupine I1D.

Záver: Ischemické poškodenie ligáciou žalúdočných tepien bolo predominantne pozorované v skupinách I1H a I1D avšak nie v skupine I7D. Táto práca prezentuje jednoduchú metódu verifikácie ischemických zmien žalúdočného tubulu.

Klíčová slova:

potkan – žalúdok – Ischemia – ezofagogastrická anastomóza – histologické zmeny


Sources
  1. Bonavina L. Progress in the esophagogastric anastomosis and the challenges of minimally invasive thoracoscopic surgery. Ann Transl Med. 2021 May;9(10):907. doi: 10.21037/atm.2020.03.66.
  2. Deng J, Su Q, Ren Z, et al. Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis. Onco Targets Ther. 2018 Sep 20;11:6057−6069. doi: 10.2147/OTT. S169488.
  3. Chidi AP, Etchill EW, Ha JS, et al. Effect of thoracic versus cervical anastomosis on anastomotic leak among patients who undergo esophagectomy after neoadjuvant chemoradiation. J Thorac Cardiovasc Surg. 2020 Oct;160(4):1088−1095. doi: 10.1016/j.jtcvs.2020.01.089. Epub 2020 Feb 20.
  4. Mingol-Navarro F, Ballester-Pla N, Jimenez-Rosellon R. Ischaemic conditioning of the stomach previous to esophageal surgery. J Thorac Dis. 2019 Apr;11(Suppl 5):S663−S674. doi: 10.21037/jtd. 2019.01.43.
  5. Thomas DM, Langford RM, Russell RC, et al. The anatomical basis for gastric mobilization in total oesophagectomy. Br J Surg. 1979 Apr;66(4):230−233. doi: 10.1002/bjs.1800660404. PMID: 454988.
  6. Liebermann-Meffert DM, Meier R, Siewert JR. Vascular anatomy of the gastric tube used for esophageal reconstruction. Ann Thorac Surg. 1992 Dec;54(6):1110−1115. doi: 10.1016/0003-4975(92)90077-h. PMID: 1449294.
  7. Lamas S, Azuara D, de Oca J, et al. Time course of necrosis/apoptosis and neovascularization during experimental gastric conditioning. Dis Esophagus. 2008;21(4):370−376. doi: 10.1111/j.1442-2050.2007.00772.x.
  8. Procházka V, Grolich T, Čan V, et al. Results of minimally invasive esophagectomy for esophageal cancer performed after ischemic gastric conditioning. Rozhl Chir. 2018 Winter;97(7):335-341. English.
  9. Kitano M, Bernsand M, Kishimoto Y, et al. Ischemia of rat stomach mobilizes ECL cell histamine. Am J Physiol Gastrointest Liver Physiol. 2005 May;288(5):G1084−1090. doi: 10.1152/ajpgi.00004.2004. Epub 2005 Jan 20.
  10. Bludau M, Hölscher AH, Vallböhmer D, et al. Ischemic conditioning of the gastric conduit prior to esophagectomy improves mucosal oxygen saturation. Ann Thorac Surg. 2010 Oct;90(4): 1121−1126. doi: 10.1016/j.athoracsur.2010.06.003.
  11. Michalinos A, Antoniou SA, Ntourakis D, et al. Gastric ischemic preconditioning may reduce the incidence and severity of anastomotic leakage after οesophagectomy: a systematic review and meta-analysis. Dis Esophagus 2020 Oct 12;33(10):doaa010. doi: 10.1093/dote/ doaa010.
  12. Jogiat UM, Sun WYL, Dang JT, et al. Gastric ischemic conditioning prior to esophagectomy reduces anastomotic leaks and strictures: a systematic review and meta-analysis. Surg Endosc. 2022 Jul;36(7):5398−5407. doi: 10.1007/ s00464-021-08866-4. Epub 2021 Nov 15.
  13. Perry KA, Banarjee A, Liu J, et al. Gastric ischemic conditioning increases neovascularization and reduces inflammation and fibrosis during gastroesophageal anastomotic healing. Surg Endosc. 2013 Mar;27(3):753−760. doi: 10.1007/s00464012-2535-6. Epub 2012 Dec 18.
  14. Prudius V, Procházka V, Pavlovský Z, et al. Neovascularization after ischemic conditioning of the stomach and the influence of follow-up neoadjuvant chemotherapy thereon. Wideochir Inne Tech Maloinwazyjne 2018 Sep;13(3):299−305. doi: 10.5114/wiitm.2018.75907. Epub 2018 May 22.
  15. Prochazka V, Marek F, Kunovsky L, et al. Comparison of cervical anastomotic leak and stenosis after oesophagectomy for carcinoma according to the interval of the stomach ischaemic conditioning. Ann R Coll Surg Engl. 2018 Sep;100(7):509−514. doi: 10.1308/rcsann.2018.0066. Epub 2018 Jun 18.
  16. Aiolfi A, Bona D, Bonitta G, et al. Gastric Ischemic Conditioning (GIC) International Collaborative Group. Effect of gastric ischemic conditioning prior to esophagectomy: systematic review and meta-analysis. Updates Surg. 2023 Sep;75(6):1633−1643. doi: 10.1007/ s13304-023-01601-9. Epub 2023 Jul 27.
  1. Beck SM, Malay MB, Gagné DJ, et al. Experimental model of laparoscopic gastric ischemic preconditioning prior to transhiatal esophagectomy. Surg Endosc. 2011 Aug;25(8):2470−2477. doi: 10.1007/ s00464-010-1568-y. Epub 2011 Feb 8.
  2. Wang J. Neutrophils in tissue injury and repair. Cell Tissue Res. 2018 Mar; 371(3):531−539. doi: 10.1007/s00441-017-2785-7. Epub 2018 Jan 30.
  3. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021;122(7):474−488. doi: 10.4149/BLL_2021_078.
  4. Reavis KM, Chang EY, Hunter JG, et al. Utilization of the delay phenomenon improves blood flow and reduces collagen deposition in esophagogastric anastomoses. Ann Surg. 2005 May;241(5):73645; discussion 745−747. doi: 10.1097/01. sla.0000160704.50657.32.
  5. Kechagias A, van Rossum PSN, Ruurda JP, et al. Ischemic conditioning of the stomach in the prevention of esophagogastric anastomotic leakage after esophagectomy. Ann Thorac Surg. 2016 Apr;101(4):1614−1623.  doi:  10.1016/j.athoracsur.2015.10.034. Epub 2016 Feb 5. PMID: 26857639.
  6. Berrisford RG, Veeramootoo D, Parameswaran R, et al. Laparoscopic ischaemic conditioning of the stomach may reduce gastric-conduit morbidity following total minimally invasive oesophagectomy. Eur J Cardiothorac Surg. 2009 Nov;36(5):888−893; discussion 893. doi: 10.1016/j.ejcts.2009.01.055. Epub 2009 Jul 16.
  7. Diana M, Hübner M, Vuilleumier H, et al. Redistribution of gastric blood flow by embolization of gastric arteries before esophagectomy. Ann Thorac Surg. 2011 May;91(5):1546−1551. doi: 10.1016/j.atho-racsur.2011.01.081. Epub 2011 Mar 21.
  8. Farran L, Miro M, Alba E, et al. Preoperative gastric conditioning in cervical gastroplasty. Dis Esophagus. 2011 May;24(4):205−210. doi: 10.1111/j.14422050.2010.01115.x. Epub 2010 Oct 11.
  9. Drescher DG, Vogt J, Gabriel M, et al. Model of wound healing for esophagogastric anastomoses in rats. Eur Surg Res. 2012;48(4):194−199. doi: 10.1159/ 000338625. Epub 2012 Jun 7.

doc. MUDr. Ivan Kováč, PhD.
2
nd Department of Surgery,
Louise Pasteur University Hospital and P. J. Šafárik University
Rastislavova 43, 04011 Košice, Slovak Republic
e-mail:
ivankovac.kovi@gmail.com
ORCID: 0000-0001-6717-5818

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