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2016 ; 12
(3
): 2038-2044
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Esophageal anastomosis - how the granulation phase of wound healing improves the
incidence of anastomotic leakage
#MMPMID27602135
Tabola R
; Augoff K
; Lewandowski A
; Ziolkowski P
; Szelachowski P
; Grabowski K
Oncol Lett
2016[Sep]; 12
(3
): 2038-2044
PMID27602135
show ga
A two-stage esophagectomy with an interval for reconstruction of the esophagus
creates an opportunity for the esophageal stump to recover from vessel injury and
allows the formation of granulation tissue rich in proangiogenic factors,
including transforming growth factor ? (TGF-?) and vascular endothelial growth
factor A (VEGF-A), which may have an impact on anastomosis healing. The present
study comprised 25 patients (27 in total, 2 succumbed to complications following
surgery) who underwent two-stage esophagectomy for squamous cell carcinoma in the
Department of Gastrointestinal and General Surgery, Wroc?aw Medical University
(Wroc?aw, Poland) between January 2007 and December 2012. Immunohistochemical
staining for VEGF-A and TGF-? was performed to evaluate esophageal wall specimens
at the time of esophagostomy construction and prior to anastomosis, in which the
cervical esophagus was connected with the colon or ileum. At the time of
reconstructive surgery, a significant increase in microvessel density was
observed in all esophageal specimens (P<0.03). Significant differences were also
identified in the immunohistochemical staining intensity of TGF-? and VEGF-A in
the epithelium of all esophageal specimens between biopsies obtained from normal
esophageal tissues at the time of esophagectomy and during reconstructive
surgery. Delayed anastomosis construction provides an advantage for the
esophageal stump to accumulate proangiogenic growth factors, which overlap with
the subsequent proliferative stage of the anastomosed tissue and thus supports
its recovery, creating an optimal environment for the healing of any fistulas.
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