uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Perfusion of the gastric conduit during esophagectomy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.ORCID iD: 0000-0001-6561-9734
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
2017 (English)In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050, Vol. 30, no 1, p. 143-149Article in journal (Refereed) Published
Abstract [en]

In esophageal cancer surgery, perfusion of the gastric conduit is a critical issue. Measurement of gastric intramucosal pH (pHi ) is a method to identify anaerobic metabolism as a sign of impaired perfusion. In this study we aimed to monitor changes in the perfusion of the gastric conduit at key steps during and after esophagectomy. pHi was measured per- and postoperatively using intermittent gastric tonometry in 32 patients undergoing open, 65%, or video-assisted thoracoscopic esophagectomy for esophageal cancer. Measurements focused on the surgical steps when the vascular supply to the gastric conduit was altered. A tonometry catheter was successfully placed in all patients and a decrease in pHi (mean ± SD) was observed from baseline to after the division of the short gastric vessels (7.33 ± 0.07 to 7.29 ±  0.07, P  = 0.005). A further reduction after the ligation of the left gastric artery (7.26 ± 0.08, P  < 0.001) and after final linear stapling the gastric conduit (7.15 ± 0.13, P  < 0.001) was observed. Two hours after surgery, pHi increased (7.24 ± 0.09, P  = 0.002). In contrast to open surgery, a trend towards less reduction in pHi was seen in thoracoscopic surgery. Patients with anastomotic leaks had lower pHi on the first postoperative day (7.12 ± 0.05 vs. 7.27 ± 0.08, P  = 0.040). It can be concluded that each surgical step altering the vascular supply to the gastric conduit resulted in detectable changes, however transient, in pHi . Patients with low pHi on the first postoperative day were more prone to have clinically relevant anastomotic leaks.

Place, publisher, year, edition, pages
2017. Vol. 30, no 1, p. 143-149
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:uu:diva-308550DOI: 10.1111/dote.12537ISI: 000399668800029PubMedID: 27766735OAI: oai:DiVA.org:uu-308550DiVA, id: diva2:1050142
Available from: 2016-11-28 Created: 2016-11-28 Last updated: 2018-03-20Bibliographically approved
In thesis
1. Esophageal- and Gastroesophageal Junctional Cancer: Aspects on Staging, Treatment and Results
Open this publication in new window or tab >>Esophageal- and Gastroesophageal Junctional Cancer: Aspects on Staging, Treatment and Results
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Esophageal- and gastroesophageal junctional (GEJ) cancer is the sixth cause of cancer-related death worldwide. Some improvements in care are attributed to nationwide disease-specific registries, preoperative staging and increased understanding of mechanisms affecting patient selection. Surgery, however, is a cornerstone for treatment where minimally invasive surgery and increased understanding of perioperative physiology may be beneficial. The aims of this thesis were to validate the Swedish national registry for esophageal and gastric cancer (NREV) and to explore mechanisms in patient selection, perioperative physiology, treatment-related outcomes and staging.

A validation study with re-abstracted data on 400 patients determined NREV comparable to other similar registries and to have a completeness of 95.5 %. Overall accuracy was 91.1 % throughout the registry and timeliness to reporting was adequate.

In a cohort of 4112 patients from NREV, high education level was associated with an increased probability of being allocated to curative treatment, as was the presence of a multidisciplinary treatment conference. High education level was associated with improved survival.

By measuring intramucosal pH (pHi) in 32 patients, to describe perfusion in the gastric conduit during esophagectomy, a reduction in perfusion was seen at all surgical steps altering vascular supply to the conduit but foremost after gastric tube construction by linear stapling. Patients with low pHi on the first postoperative day were more prone to anastomotic insufficiency.

In 116 patients undergoing esophagectomy (65 open and 51 minimally invasive), a retrospective cohort study regarding surgical oncological results and postoperative complications was conducted. Lymph node yield was increased, peroperative blood loss and in-hospital stay were reduced with minimally invasive esophagectomy. Postoperative complications were unaffected by surgical approach. 

In a prospective study of nineteen patients, whole-body integrated PET/MRI was compared to PET/CT in preoperative staging. PET/MRI was safe and feasible. Accuracy and correlations between modalities were good regarding tumor characteristics and N- and M-staging. In T-staging there were discrepancies indicating differences between modalities.

The thesis presents data on the quality of NREV for future research and elaborates on patient selection, staging, perioperative physiology and treatment-related outcomes for patients with esophageal- and GEJ cancer.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 95
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1447
Keywords
Esophageal cancer, Education level, Tonometry, Lymphadenectomy, PET/MRI
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-346690 (URN)978-91-513-0286-7 (ISBN)
Public defence
2018-05-11, Grönwallsalen, ingång 70bv, Akademiska sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2018-04-16 Created: 2018-03-20 Last updated: 2018-06-08

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Linder, GustavHedberg, JakobBjörck, MartinSundbom, Magnus

Search in DiVA

By author/editor
Linder, GustavHedberg, JakobBjörck, MartinSundbom, Magnus
By organisation
Upper Abdominal SurgeryVascular Surgery
In the same journal
Diseases of the esophagus
Gastroenterology and Hepatology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 360 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf