Staged esophagectomy: surgical legacy or a bailout option?
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Staged esophagectomy: surgical legacy or a bailout option? Dimitrios Schizas1 · Adamantios Michalinos2 · Athanasios Syllaios1 · Dionysios Dellaportas3 · Emmanouil I. Kapetanakis4 · Georgios Hadjigeorgiou2 · Chrysovalantis Vergadis1 · Konstantinos Lasithiotakis5 · Theodoros Liakakos1 Received: 10 June 2019 / Accepted: 20 September 2019 © Springer Nature Singapore Pte Ltd. 2019
Abstract Staged esophagectomy was developed in the mid-twentieth century in an attempt to reduce high rates of postoperative morbidity and mortality. Nowadays, the operation has almost been abandoned due to its significant disadvantages, especially the need for multiple surgeries, inability of patients to feed between operations, and morbidity of esophageal stoma. However, staged esophagectomy is still occasionally useful for very high-risk patients and in particular cases, for example multiple cancers of the aerodigestive tract and emergent esophagectomy. Staged esophagectomy is based on the division of surgical stress into two operations, which gives the patient time to recover before final restoration. Gastric tube ischemic preparation may be a more important mechanism in staged esophagectomy. This approach may survive and expand with the application of ischemic gastric pre-conditioning through embolization or laparoscopic ligation of the gastric arteries, which is a less explored and promising technique. Keywords Staged esophagectomy · Esophagectomy · Esophageal resection · Gastric ischemic preconditioning
Introduction Esophageal cancer is a highly aggressive malignancy associated with a dismal prognosis. Esophageal resection remains the cornerstone treatment for these patients. However, esophagectomy is a highly invasive and complex operation, associated with high morbidity and mortality even in high-volume referral centers. Among all complications, anastomotic leakage and pulmonary complications are the
* Adamantios Michalinos [email protected] 1
First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital Ag, Thoma 17 str. Goudi, Athens, Greece
2
Department of Anatomy, European University of Cyprus, Diogenous 6 Str, CY‑2404 Engomi, Nicosia, Cyprus
3
Second Department of Surgery, National and Kapodistrian University of Athens, Aretaieion University Hospital, Vasillisis Sofias 76 str, Athens, Greece
4
Department of Thoracic Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str. Chaidari, Athens, Greece
5
Department of General Surgery, University Hospital of Heraklion, Panepistimiou 12 str, Heraklion, Greece
most dreadful, and are relatively common. Furthermore, esophageal cancer patients invariably have associated comorbidities due to old age, exposure to esophageal carcinogenic factors, presumably alcohol and tobacco, and their poor nutritional status. Consequently, esophageal cancer patients often have limited reserves in addition to postoperative complications [1–3]. Staged esophagectomy (SE) was devel
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