Universität zu Köln

Lemties, Julian, Scheidt, Carolin, Jung, Jin-On ORCID: 0000-0001-6121-0114, Wirsik, Naita M. ORCID: 0000-0003-1619-6354, Lukomski, Leandra ORCID: 0000-0002-6998-2255, Krauss, Dolores, Grabenkamp, Anders, Stier, Alexander R., Lyu, Su Ir ORCID: 0009-0002-4125-6048, Damanakis, Alexander I. ORCID: 0000-0002-1155-5541, Babic, Benjamin, Quaas, Alexander ORCID: 0000-0002-3537-6011, Schmidt, Thomas ORCID: 0000-0002-7166-3675, Fuchs, Hans F. ORCID: 0000-0003-4764-8050, Bruns, Christiane J. ORCID: 0000-0001-6590-8181, Schröder, Wolfgang ORCID: 0000-0002-8700-069X and Schiffmann, Lars M. ORCID: 0000-0002-2320-5004 (2025). Vascularity of the gastric conduit predicts complications after Ivor-Lewis esophagectomy. Surgical Endoscopy, 39 (6). pp. 3839-3847. Springer Nature. ISSN 0930-2794

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Abstract

Background: Anastomotic leakage (AL) contributes to postoperative morbidity and mortality after Ivor-Lewis esophagectomy. Vascular high-risk patients show a significantly increased risk of AL. We previously showed that laparoscopic ischemic conditioning (ISCON) of the stomach prior esophagectomy in these high-risk patients is a safe procedure that induces neo- angiogenesis at the anastomotic site. Our data also suggested that this directly impacts on anastomotic healing. To further investigate the hypothesis that gastric conduit vascularization directly influences postoperative morbidity, we evaluated gastric conduit vascularity in a cohort of patients undergoing two-stage esophagectomy prior to the ISCON era. Material and Methods: Seventy-nine patients who underwent two-stage esophagectomy from 2016 to 2021 at our center were retrospectively analyzed from a prospectively maintained database. Microvessel density (MVD) of the gastric conduit at the anastomotic region was evaluated by CD34 staining of the gastric stapler ring. Analysis of microvessel density (MVD) was performed using ImageJ. Patients were stratified into low- and high-MVD groups, and MVD was correlated with clinical outcomes. Results: Patients with a high MVD showed a significantly lower rate of anastomotic leakage (AL) in comparison to patients with low MVD (6.25% vs. 22.58% p=0.043). Furthermore, a high MVD was associated with a lower rate of major complica- tions (Clavien Dindo ≥ IIIb) (12.50% vs. 38.71% p=0.012) and a shorter hospital stay (17.9 days vs. 23.1 days, p=0.045). Conclusion Vascularization of the stomach might function as surgical biomarker of AL in patients undergoing two-stage esophagectomy. Prospective trials have to further substantiate this finding.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Lemties, Julian UNSPECIFIED UNSPECIFIED UNSPECIFIED Scheidt, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Jung, Jin-On UNSPECIFIED https://orcid.org/0000-0001-6121-0114 UNSPECIFIED Wirsik, Naita M. UNSPECIFIED https://orcid.org/0000-0003-1619-6354 UNSPECIFIED Lukomski, Leandra UNSPECIFIED https://orcid.org/0000-0002-6998-2255 UNSPECIFIED Krauss, Dolores UNSPECIFIED UNSPECIFIED UNSPECIFIED Grabenkamp, Anders UNSPECIFIED UNSPECIFIED UNSPECIFIED Stier, Alexander R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lyu, Su Ir UNSPECIFIED https://orcid.org/0009-0002-4125-6048 UNSPECIFIED Damanakis, Alexander I. UNSPECIFIED https://orcid.org/0000-0002-1155-5541 UNSPECIFIED Babic, Benjamin UNSPECIFIED UNSPECIFIED UNSPECIFIED Quaas, Alexander UNSPECIFIED https://orcid.org/0000-0002-3537-6011 UNSPECIFIED Schmidt, Thomas UNSPECIFIED https://orcid.org/0000-0002-7166-3675 UNSPECIFIED Fuchs, Hans F. UNSPECIFIED https://orcid.org/0000-0003-4764-8050 UNSPECIFIED Bruns, Christiane J. UNSPECIFIED https://orcid.org/0000-0001-6590-8181 UNSPECIFIED Schröder, Wolfgang UNSPECIFIED https://orcid.org/0000-0002-8700-069X UNSPECIFIED Schiffmann, Lars M. UNSPECIFIED https://orcid.org/0000-0002-2320-5004 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-809834
Identification Number:	10.1007/s00464-025-11780-8
Journal or Publication Title:	Surgical Endoscopy
Volume:	39
Number:	6
Page Range:	pp. 3839-3847
Number of Pages:	9
Date:	8 June 2025
Publisher:	Springer Nature
ISSN:	0930-2794
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Chirurgie > Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie Faculty of Medicine > Pathologie und Neuropathologie > Institut für Pathologie
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Esophageal cancer · Esophagectomy · Ischemic conditioning · Postoperative complications · Gastric conduit · Neoangiogenesis English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80983