Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina Milano, 60, 20132, Milan, MI, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Surg Endosc. 2020 Dec;34(12):5649-5659. doi: 10.1007/s00464-020-07924-7. Epub 2020 Aug 27.
Anastomotic leakage (AL) during Ivor-Lewis esophagectomy (ILE), owing to gastric conduit (GC) ischemia, is a serious complication. Measurement parameters during intraoperative ICG fluorescence angiography (ICG-FA) are unclear. We aimed to identify objective ICG-FA parameters associated with AL.
Patients > 18 years with an indication for ILE were enrolled. ICG-FA was performed at the abdominal and thoracic stage, and data, such as time of fluorescence appearance, speed of ICG perfusion, quality of GC perfusion (good, poor, ischemic), blood pressure, baseline patient characteristics, GC dimensions, and other intraoperative parameters were collected. On postoperative day 4 to 6, Gastrografin swallow radiography was performed. AL development was classified based on the Clavien-Dindo and SISG severity classifications. Univariate analysis with a 95% confidence level (p < 0.05) was performed. Factors with p < 0.05 were included in the multivariate analysis.
100 patients were enrolled. During ICG-FA, evaluation of subjective perfusion was a very specific test (94.1%) with good negative predictive value (NPV 71.9%, p 0.034), but not powerful enough to detect patients at risk of leak (sensibility 21.8%, PPV 63.6%). The GC perfusion speed (cm/s) after gastric vascular isolation and before tubulization showed a significant association with AL (p < 0.003). Median arterial blood pressure in the thoracic stage (p < 0.001) or use of inotropic (p < 0.033) was associated with AL development.
GC perfusion speed at ICG-FA is an objective parameter that could predict AL risk. Other results emphasize the importance of the microcirculation in the development of AL.
由于胃管（GC）缺血，Ivor-Lewis 食管切除术（ILE）期间的吻合口漏（AL）是一种严重的并发症。术中吲哚菁绿荧光血管造影（ICG-FA）的测量参数尚不清楚。我们旨在确定与 AL 相关的客观 ICG-FA 参数。
纳入年龄大于 18 岁且有 ILE 适应证的患者。在腹部和胸部阶段进行 ICG-FA，并收集荧光出现时间、ICG 灌注速度、GC 灌注质量（良好、不良、缺血）、血压、基线患者特征、GC 尺寸和其他术中参数等数据。术后第 4 至 6 天，行胃造影吞咽造影检查。根据 Clavien-Dindo 和 SISG 严重程度分类对 AL 发展进行分类。采用 95%置信水平（p < 0.05）进行单因素分析。将 p < 0.05 的因素纳入多因素分析。
共纳入 100 例患者。在 ICG-FA 期间，主观灌注评估是一种特异性非常高的测试（94.1%），具有良好的阴性预测值（NPV 71.9%，p = 0.034），但不足以检测有漏液风险的患者（敏感性 21.8%，PPV 63.6%）。胃血管隔离后和管腔化前 GC 灌注速度（cm/s）与 AL 显著相关（p < 0.003）。胸段中位动脉血压（p < 0.001）或使用正性肌力药（p < 0.033）与 AL 发展相关。
ICG-FA 时 GC 灌注速度是预测 AL 风险的客观参数。其他结果强调了微循环在 AL 发展中的重要性。
