Ischemic conditioning of the stomach may reduce the incidence of esophagogastric anastomotic leaks complicating esophagectomy: a hypothesis

Esophagogastric anastomotic leaks are a major cause of morbidity and mortality after esophagectomy. Occult ischemia of the mobilized and partially devascularized gastric fundus is an important cause of esophagogastric leaks. The author hypothesizes that the vascularity of the gastric fundus can be improved, and anastomotic leaks reduced, by a process of ischemic conditioning (delay phenomenon). Laparoscopic partial gastric devascularization could be performed 2-3 weeks before esophagectomy. The gastric fundus would have time to re-establish an abundant blood supply before being mobilized and anastomosed to the esophagus. Since laparoscopic partial devascularization could be done at the time of laparoscopic cancer staging, gastric ischemic conditioning would not necessarily add cost or morbidity to the overall treatment of esophageal cancer. Laboratory and clinical evidence are presented to support this hypothesis.