Article
Perfusion assessment of the gastric conduit after esophagectomy by laser-induced tissue fluorescence: A match-paired study
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Authors
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Kai Nowak
- Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
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Ioannis Karampinis
- Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
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Christina Mertens
- Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
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Ulrich Ronellenfitsch
- Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
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Peter Kienle
- Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
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Stefan Post
- Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
| Published: | April 21, 2016 |
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Outline
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Background: Anastomotic leakage after esophagectomy is a severe complication associated with increased mortality. One of the main reasons leading to an anastomotic leakage is the poor perfusion of the gastric tube. Until recently surgical experience was the main tool used to assess the sufficiency of the blood perfusion of the anastomotic region.
Materials and methods: Laser-induced fluorescence of indocyanin-green (ICG) tissue angiography was used to evaluate the perfusion of the anastomotic region in 20 patients undergoing an esophagectomy with gastric pull up with intrathoracic or cervical anastomosis. After creating the gastric sleeve 7,5 mg of ICG were intravenously administered and flushed with normal saline. The images were retrieved (PinPoint, Novadaq) beginning 5 seconds after the injection. Results of the ICG patients were compared to a cohort of 56 prior patients operated without ICG fluorescence angiography. For the better interpretation of the results, patient matched pairs were formed and analyzed according to age, gender, UICC stage, type of resection, ASA and type of neoadjuvant treatment.
Results: The microperfusion of the gastric sleeve was assessed using a charge coupled device video camera. In 9 cases we performed a further shortening of the gastric conduit according to the findings. The anastomosis could always be performed in an area of good ICG perfusion. Anastomotic leakage rate was 5% (1/20) in the ICG patients compared to 18% (10/56) in the retrospective cohort (p=0.269) and 25% (5/20) in the matched-pairs (p=0.180).
Conclusion: ICG tissue angiography represents a feasible and reliable technical support in the evaluation of perfusion of the gastric tube after esophagectomy. Anastomotic leakage rate was much lower in the ICG tissue angiography group. However, probably due to small sample size, no statistical significance could be observed. A prospective trial is needed to assess the exact interpretation and outcome of ICG tissue angiography in esophagectomies.
