Successful muscle regeneration by a homologous microperforated scaffold seeded with autologous mesenchymal stromal cells in a porcine esophageal substitution model

Background: Since the esophagus has no redundancy, congenital and acquired esophageal diseases often require esophageal substitution, with complicated surgery and intestinal or gastric transposition. Peri-and-post-operative complications are frequent, with major problems related to the food transit and reflux. During the last years tissue engineering products became an interesting therapeutic alternative for esophageal replacement, since they could mimic the organ structure and potentially help to restore the native functions and physiology. The use of acellular matrices pre-seeded with cells showed promising results for esophageal replacement approaches, but cell homing and adhesion to the scaffold remain an important issue and were investigated. Methods: A porcine esophageal substitute constituted of a decellularized scaffold seeded with autologous bone marrow-derived mesenchymal stromal cells (BM-MSCs) was developed. In order to improve cell seeding and distribution throughout the scaffolds, they were micro-perforated by Quantum Molecular Resonance (QMR) technology (Telea Electronic Engineering). Results: The treatment created a microporous network and cells were able to colonize both outer and inner layers of the scaffolds. Non seeded (NSS) and BM-MSCs seeded scaffolds (SS) were implanted on the thoracic esophagus of 4 and 8 pigs respectively, substituting only the muscle layer in a mucosal sparing technique. After 3 months from surgery, we observed an esophageal substenosis in 2/4 NSS pigs and in 6/8 SS pigs and a non-practicable stricture in 1/4 NSS pigs and 2/8 SS pigs. All the animals exhibited a normal weight increase, except one case in the SS group. Actin and desmin staining of the post-implant scaffolds evidenced the regeneration of a muscular layer from one anastomosis to another in the SS group but not in the NSS one. Conclusions: A muscle esophageal substitute starting from a porcine scaffold was developed and it was fully repopulated by BM-MSCs after seeding. The substitute was able to recapitulate in shape and function the original esophageal muscle layer.

RA05.05: STOMACH PRESERVED ILEOCOLIC INTERPOSITION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Background A stomach is the first choice as an esophageal substitute after esophagectomy for cancer. In case with a history of gastrectomy, concurrent gastric disease, the ileo-colon is used as an esophageal substitute in our hospital. From 2007, as a method of preservation of the gastrointestinal function, we have provided the reconstruction of stomach preserved ileo-colic interposition. Methods 1990–2017.12, 227 patients underwent colon interposition after esophagectomy with extended lymphadenectomy. Until 1997, we selected the colon graft based on colon vessel finding during surgery. From 1998, we assumed ileo-colon first choice. From 2007, we started stomach preserved ileo-colic interposition. Between 2007 and 2017, we performed this method in 108/142 colon interposition patients. We examined these 108 patients to know the recent result of ileo-colon interposition. Results An average of 108 patients is 61 years. The cases without preoperative treatment was 38 cases (35%). Endoscopic resection was done in 23 cases (21%). 38 received preoperative chemo and 9 CRT. Clinical TNM was I/II/III/IV = 62/20/24/2. We performed lymphadenectomy with three field in 70 and two in 38. Route of reconstruction was retrosternal in 99(92%), a posterior mediastinal in 8. Microvascular anastomosis was conducted in one. The anastomosis of all cases performed hand-sewn end-to-side anastomosis in neck. The incidence of postoperative morbidity is one patient had anastomotic minor leakage (1%), one had pneumonia to need intubation. 4 patients experienced bowel obstruction, 1 required surgery. Endoscopy had done 4–12 month later, there were no patients have reflux esophagitis or anastomotic stenosis. 12 patients had colon-gastric anastomotic ulcer. PPI was started. The weight rate of decline of the 12 months after surgery was an average of 9%. 32% patients have diarrhea. Conclusion Stomach preserved ileo-colic interposition after esophagectomy with extended lymphadenectomy is feasible and have a favorable outcome. Keep up long-term quality of life and decrease in complications after the long-term progress is expected. Disclosure All authors have declared no conflicts of interest.

Prognostic factors influencing morbidity and mortality in esophageal carcinoma

PURPOSE: In 1980, operative mortality for esophageal resection was 29%. Over the last 15 years, technical and critical care improvements contributed to the reduction of postoperative mortality rate to 8%. The aim of this study is to analyze retrospectively the role of different factors (surgical procedure, stage of the disease, and anesthetic risk) on the postoperative mortality of 63 patients that underwent esophagectomy with gastric interposition for cancer. METHODS: Seventy-two patients underwent esophagectomy. The stomach was the esophageal substitute in 63 cases. Surgical procedures included transthoracic esophagectomy in 49 patients and transhiatal esophagectomy in 14 cases. Among the 49 transthoracic esophagectomy patients, there were 18 patients with a high anesthetic risk (ASA III). Among the patients that underwent transhiatal esophagectomy, there were 10 patients with a high anesthetic risk (ASA III). RESULTS: The operative mortality rate was 14% (2/14) in transhiatal esophagectomy group and 22% (11/49) in transthoracic esophagectomy group (P = ns). The postoperative mortality of patients with a high anesthetic risk (ASA III) was 47% (8/17) after transthoracic esophagectomy and 10% (1/10) after transhiatal esophagectomy (P <0.05). DISCUSSION: In our experience, the operative mortality was nearly 18% (16.6% after transhiatal esophagectomy and 20.8% after transthoracic esophagectomy). Among the patients with a high anesthetic risk (ASA III) that underwent surgery, the postoperative mortality was significantly lower after transhiatal esophagectomy (10%) compared to transthoracic esophagectomy (47%) (P <0.05).