Ohi Masaki, Toiyama Yuji, Mohri Yasuhiko, Saigusa Susumu, Ichikawa Takashi, Shimura Tadanobu, Yasuda Hiromi, Okita Yoshiki, Yoshiyama Shigeyuki, Kobayashi Minako, Araki Toshimitsu, Inoue Yasuhiro, Kusunoki Masato
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507 Japan.
Department of Innovative Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507 Japan.
Esophagus. 2017;14(4):351-359. doi: 10.1007/s10388-017-0585-5. Epub 2017 Jun 28.
Anastomotic leak (AL) following esophagectomy for esophageal cancer (EC) remains an important cause of prolonged hospitalization and impaired quality of life. Recently, indocyanine green (ICG) fluorescein imaging has been used to evaluate the gastric conduit blood supply during EC surgery. Although several factors have been reported to be associated with AL, no studies have evaluated the relationships between risk factors for AL, including ICG fluorescein imaging. The purpose of this study was to investigate the risk factors associated with AL following esophagectomy and to evaluate the impact of ICG fluorescein imaging of the gastric conduit during EC surgery.
One hundred and twenty patients undergoing esophagectomy with esophagogastric anastomosis for EC were enrolled in this retrospective study. Clinicopathological factors, preoperative laboratory variables, and surgical factors, including ICG fluorescence imaging, were analyzed to determine their association with AL. Univariate and multivariate logistic regression analysis was used to evaluate the impact of each of these factors on the incidence of AL.
Among the 120 patients enrolled in the study, 10 (8.3%) developed AL. Univariate analysis demonstrated an increased risk of AL in patients with a high-neutrophil-to-lymphocyte ratio ( = 0.0500) and in patients who did not undergo ICG fluorescein imaging ( = 0.0057). Multivariate analysis revealed that the absence of ICG imaging was an independent risk factor for AL ( = 0.0098).
Using ICG fluorescein imaging to evaluate blood flow in the gastric conduit might decrease the incidence of AL following EC surgery.
食管癌（EC）切除术后吻合口漏（AL）仍是导致住院时间延长和生活质量下降的重要原因。最近，吲哚菁绿（ICG）荧光成像已被用于评估EC手术期间胃代食管的血供。尽管已有报道称有几个因素与AL相关，但尚无研究评估包括ICG荧光成像在内的AL危险因素之间的关系。本研究的目的是调查EC切除术后与AL相关的危险因素，并评估EC手术期间胃代食管ICG荧光成像的影响。
本回顾性研究纳入了120例行EC食管胃吻合术的患者。分析临床病理因素、术前实验室指标和手术因素，包括ICG荧光成像，以确定它们与AL的关联。采用单因素和多因素logistic回归分析评估这些因素对AL发生率的影响。
在本研究纳入的120例患者中，10例（8.3%）发生了AL。单因素分析显示，中性粒细胞与淋巴细胞比值高的患者（P = 0.0500）和未接受ICG荧光成像的患者（P = 0.0057）发生AL的风险增加。多因素分析显示，未进行ICG成像是AL的独立危险因素（P = 0.0098）。
使用ICG荧光成像评估胃代食管血流可能会降低EC手术后AL的发生率。
