From the Guidelines
The right gastroepiploic artery should be preserved during gastric mobilization for esophagectomy with gastric tube reconstruction for intrathoracic anastomosis. This artery serves as the primary blood supply to the gastric conduit after mobilization and is critical for ensuring adequate perfusion of the newly created gastric tube. During the procedure, the left gastric, short gastric, and left gastroepiploic arteries are typically divided to allow for adequate mobilization of the stomach, while the right gastroepiploic artery and its arcade along the greater curvature must be carefully preserved, as stated in the study 1. Maintaining this vessel is essential for preventing ischemia of the gastric conduit, which could lead to anastomotic leakage, stricture formation, or necrosis of the gastric tube. The right gastroepiploic artery provides blood flow to the distal portion of the gastric tube, which will form the esophagogastric anastomosis in the thorax. Some key points to consider during this procedure include:
- The stomach is mobilized for use as the conduit, with dissection of the celiac and left gastric lymph nodes, division of the left gastric artery, and preservation of the gastroepiploic and right gastric arteries, as described in the study 1.
- The approach may be used for lesions at any thoracic location, but proximal esophageal margin will be inadequate for tumors in the middle esophagus.
- Transhiatal esophagectomy was associated with lower morbidity than transthoracic esophagectomy with extended en bloc lymphadenectomy, according to the study 1. Surgeons should take care to avoid injury to this vessel during dissection and ensure that tension on the vessel is minimized when positioning the gastric tube in the thoracic cavity. The preservation of the right gastroepiploic artery is crucial for the success of the procedure and the prevention of postoperative complications, as supported by the study 1.
From the Research
Artery Preservation During Gastric Mobilization
The artery that should be preserved during gastric mobilization for esophagectomy with gastric tube reconstruction for intrathoracic anastomosis is:
- The right gastroepiploic artery, as it is considered essential for blood supply to the gastric tube 2, 3, 4
- The left gastroepiploic artery, as preserving it can help create additional length in the gastric tube 5
Importance of Preserving the Right Gastroepiploic Artery
Preserving the right gastroepiploic artery is crucial to ensure proper perfusion of the gastric conduit following esophagectomy 2, 4
- Transection of the right gastroepiploic artery does not necessarily exclude the use of a gastric conduit in Ivor-Lewis esophagectomy, as re-anastomosis can be performed 4
- In cases where the right gastroepiploic artery is injured, microvascular reconstruction can be used to salvage the gastric tube 2
Preservation of the Left Gastroepiploic Artery
Preserving the left gastroepiploic artery can help create additional length in the gastric tube, which is important for intrathoracic anastomosis 5
- The left gastroepiploic artery plays a role in the blood supply to the gastric tube, and its preservation can help ensure adequate perfusion 6