How to Cite
Abstract
Anastomotic leak and conduit necrosis are severe complications after esophagectomy. Fluorescent angiography with indocyanine green provides an opportunity to objectively evaluate conduit perfusion and, potentially, reduce the number of leaks.
Material and methods. We analyzed short-term outcomes of 26 esophagectomies performed with laser fluorescent evaluation of conduit perfusion. All patients had esophagogastic anastomosis, 14 in the neck, 12 in the pleural cavity. Conduit perfusion was assessed 30 sec after intravenous bolus injection of 6 mg of indocya-nine green with SPY2000 laser technology. The results were compared with short-term outcomes of 35 esophagectomies performed without fluorescent assessment of gastric tube perfusion.
Results. There were 6 leaks or conduit necrosis in control group while in the ICG group there were only 2 leaks on the neck: 1 in a patient with a massive intraoperative bleeding and shock, 1 in a patient with severely compromised blood supply of the gastric tube tip according to ICG imaging. No cases of conduit necrosis were found, which led to significantly lower number of severe (grade III-V Dindo-Clavien) complications, p=0,033. Conclusion Laser fluorescent angiography with indocyanine green is a useful tool which affords an objective evaluation of gastric tube perfusion and, potentially, reduces the number of severe postoperative complications after esophagectomy.
References
Еникеев Р.Ф., Бурмистров М.В., Сигал Е.И., Морошек А.А. Профилактика несостоятельности эзофагога-строанастомоза на шее при экстирпации пищевода по поводу рака с одномоментной эзофагопластикой стеблем желудка // Медицинская наука и образование Урала. - 2010. - Т. 11. - № 1. - С. 109-111.
Плаксин С.А., Саблин Е.Е. Факторы риска несостоятельности эзофагогастроанастомоза в зависимости от вида пластики пищевода. Пермский Медицинский Журнал. - 2016. - Т. 33. - С. 23-27.
Fu S.J., Ho V.P., Ginsberg J. et al. Complications, not minimally invasive surgical technique, are associated with increased cost after esophagectomy // Minim Invasive Surg. - 2016. - Vol. 2016. - P. 7690632. - DOI: 10.1155/2016/7690632
Kassis E.S., Kosinski A.S., Ross P. Jr. et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database // Ann Thorac. Surg. -2013. - Vol. 96(6). - P. 1919-1926.
Kitagawa H., Namikawa T., Iwabu J., Hanazaki K. Gastric tube reconstruction with superdrainage using indocyanine green fluorescence during esophagectomy // In Vivo. - 2017. - Vol. 31(5). - P. 1019-1021.
Kitagawa H., Namikawa T., Iwabu J. et al. Assessment of the blood supply using the indocyanine green fluorescence method and postoperative endoscopic evaluation of anastomosis of the gastric tube during esophagectomy // Surg. Endosc. - 2018. - Vol. 32(4). - P. 1749-1754.
Markar S.R., Arya S., Karthikesalingham A., Hanna G.B. Technical factors that afect anastomotic integrity following esophagectomy: systematic review and meta-analysis // Ann Surg. Oncol. - 2013. - Vol. 20. - P. 4274-4281.
Nakashima Y., Saeki H., Yukaya T. et al. Blood flow assessment with indocyanine green fluorescence angiography for pedicled omental flap on cervical esophagogastric anastomosis after esophagectomy // J. Am. Coll. Surg. - 2016. - Vol. 222(5). - P. e-67-9.
Ohi M., Toiyama Y., Mohri Y. et al. Prevalence of anastomotic leak and the impact of indocyanine green fluorescein imaging for evaluating blood flow in the gastric conduit following esophageal cancer surgery // Esophagus. - 2017. - Vol. 14(4). - P. 351-359.
Rino Y., Yukawa N., Sato T. et al. Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy // BMC Med Imaging. - 2014. - Vol. 14. - P. 18.
Ryan C.E., Paniccia A., Meguid R.A., McCarter M.D. Thransthoracic anastomotic leak after esophagectomy: current trends // Ann Surg. Oncol. - 2017. - Vol. 24(1). - P. 281-290.
Zehetner J., DeMeester S.R., Alicuben E.T. et al. Intraoperative assessment of perfusion of the gastric graft and correlation with anastomotic leaks after esophagectomy // Ann Surg. - 2015. - Vol. 262. - P. 74-78.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2019