P60 CRITICAL APPRAISAL OF GASTRIC CONDUIT ISCHAEMIC CONDITIONING PRIOR TO OESOPHAGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Abstract Aim Anastomotic leaks remain a major complication following oesophagectomy, accounting for high morbidity and mortality. Recently, gastric ischaemic conditioning (GIC) has been proposed to improve anastomotic integrity through neovascularisation of the gastric conduit. This systematic review aims to determine the impact of GIC on postoperative outcomes after oesophagectomy. Background & Methods A systematic literature search was performed to identify studies reporting GIC for any indication of oesophageal resection. Random-effects meta-analyses were conducted for main outcomes. Results Nineteen studies were included reporting GIC, of which 13 were comparative studies. GIC were performed through ligation in 13 studies and embolisation in six studies. GIC did not appear reduce anastomotic leakages (OR 0.80, CI95: 0.51 - 1.24, p=0.3), anastomotic strictures (OR 0.75, CI95: 0.35 - 1.60, p=0.5), overall complications (OR 1.02, CI95: 0.48 - 2.16, p=0.9), major complications (OR 1.06, CI95: 0.53 - 2.11, p=0.9), or in-hospital mortality (OR 0.70, CI95: 0.32 - 1.53, p=0.4). However, preconditioning reduced the rates of conduit necrosis (OR 0.30, CI95: 0.11 - 0.77, p=0.013). Conclusion Gastric preconditioning through does not appear to reduce overall rates of anastomotic leakage after oesophagectomy but seems to reduce severity of leakages. More in depth studies are recommended.