This study is a randomized clinical trial to clarify if preoperative embolization of gastric
      arteries can reduce the incidence of oesophagogastric leakage after an esophagectomy for
      esophageal cancer comparing an experimental group vs control group.

Ischemic Conditioning of the Gastric Conduit in Esophageal Cancer.

Esophageal Anastomotic Leak

Tissue Pressure of Oxygen

In patients with infracarinal esophageal carcinoma, the surgery is a complex procedure and
      with a high morbidity. It consists of a subtotal esophagectomy with tubular gastroplasty and
      cervical esophagogastric anastomosis. The most important complication is the anastomotic
      leakage with a high mortality. Among the possible causes of anastomotic leakage an important
      factor is the impaired microcirculation in the anastomotic region after the partial
      devascularization of the stomach during the surgery. There are several experimental studies
      about the different techniques to improve this vascularization and their effects on mucosal
      oxygenation. There are several methods currently used for assessing tissue oxygenation. The
      polarographic partial pressure of oxygen (pO2) electrode has been considered as the 'gold
      standard' for measuring oxygen tension. This is the reason why tissue pressure of oxygen
      (PtiO2) will be measured by Licox® (Integra Neuroscience) system in two groups. There aren't
      prospective randomized controlled trials to answer these questions. For this reason the
      investigators propose to perform a prospective randomized controlled trial in patients
      underwent on this surgery, comparing two groups: one of them will be carried out a
      preoperative arterial embolization (PAE), and the other one will be operated directly, to
      demonstrate if the ischemic conditioning by PAE can reduce the incidence of anastomotic
      esophagogastric leakage and improve the gastric conduit oxygenation.

Preoperative Arterial Embolization

Trial on Ischemic Conditioning of the Gastric Conduit in Esophageal Cancer. Effects on Oxygenation and Anastomotic Leakage.

Clinic, endoscopy or computed tomography with oral contrast of dehiscence of oesophagogastric anastomosis.

Licox oxygen monitoring system placed during the surgery in the gastric conduit. Measurements: intraoperatively and 24 hours and 48 hours after surgery.

We will analyse the correlation between the measurement of tissue pressure oxygen and the prevention of anastomotic leakage.

Plasty ischemia when one or more of the following criteria is present:
Endoscopic evidence of gastric mucosa ischemia
Evidence in a thoracoabdominal CT with endovenous contrast

Investigator will analyse the morbidity between the two groups with the common postoperative complications: - Anastomotic leakage
Wound infection
Pulmonary complications
Complications related to PAE
Cardiologic complications

Postoperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital.

investigators will consider since the day of the surgery until the day the patient will be discharged from the hospital

Preoperative artery embolization prior to esophagectomy
Tissue pressure of oxygen measurement in both arms by Licox system. The probe is inserted directly through the skin as a cervical drainage and it is fixed by Witzel technique in the gastric conduit. It is removed after the three measurements (intraoperatively, 24h and 48h after surgery) of the PtiO2 as a normal drainage.

Surgery without previous ischemic conditioning of the gastric conduit
Tissue pressure of oxygen measurement in both arms by Licox system. The probe is inserted directly through the skin as a cervical drainage and it is fixed by Witzel technique in the gastric conduit. It is removed after the three measurements (intraoperatively, 24h and 48h after surgery) of the PtiO2 as a normal drainage.

Ischemic Conditioning of the Gastric Conduit in Esophageal Cancer.

About this trial

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Placebo

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