Department of Gastrointestinal Surgery, Ghent University Hospital, 2K12 IC, Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
Surg Endosc. 2022 Aug;36(8):5812-5821. doi: 10.1007/s00464-022-09091-3. Epub 2022 Feb 14.
Anastomotic leakage (AL) after Ivor Lewis esophagectomy with intrathoracic anastomosis carries a significant morbidity. Adequate perfusion of the gastric tube (GT) is an important predictor of anastomotic integrity. Recently, near infrared fluorescent (NIRF) imaging using indocyanine green (ICG) was introduced in clinical practice to evaluate tissue perfusion. We evaluated the feasibility and efficacy of GT indocyanine green angiography (ICGA) after Ivor Lewis esophagectomy.
This retrospective analysis used data from a prospectively kept database of consecutive patients who underwent Ivor Lewis (IL) esophagectomy with GT construction for cancer between January 2016 and December 2020. Relevant outcomes were feasibility, ICGA complications and the impact of ICGA on AL.
266 consecutive IL patients were identified who matched the inclusion criteria. The 115 patients operated with perioperative ICGA were compared to a control group in whom surgery was performed according to the standard of care. ICGA perfusion assessment was feasible and safe in all 115 procedures and suggested a poorly perfused tip in 56/115 (48.7%) cases, for which additional resection was performed. The overall AL rate was 16% (43/266), with 12% (33/266) needing an endoscopic our surgical intervention and 6% (17/266) needing ICU support. In univariable and multivariable analyses, ICGA was not correlated with the risk of AL (ICGA:14.8% vs non-ICGA:17.2%, p = 0.62). However, poor ICGA perfusion of the GT predicted a higher AL rate, despite additional resection of the tip (ICGA poorly perfused: 19.6% vs ICG well perfused: 10.2%, p = 0.19).
ICGA is safe and feasible, but did not result in a reduction of AL. The interpretation and necessary action in case of perioperative presence of ischemia on ICGA have yet to be determined. Prospective randomized trials are warranted to analyze its benefit on AL in esophageal surgery. Trial registration Ethical approval for a prospective esophageal surgery database was granted by the Ethical committee of the Ghent University Hospital. Belgian registration number: B670201111232. Ethical approval for this retrospective data analysis was granted by our institutional EC.
BC-09216.
经胸入路 Ivor Lewis 食管切除术吻合口漏（AL）具有显著的发病率。胃管（GT）的充分灌注是吻合完整性的重要预测指标。最近，吲哚菁绿（ICG）近红外荧光（NIRF）成像已被引入临床实践，用于评估组织灌注。我们评估了 Ivor Lewis（IL）食管切除术后 GT 吲哚菁绿血管造影（ICGA）的可行性和疗效。
本回顾性分析使用了 2016 年 1 月至 2020 年 12 月期间连续接受 IL 食管癌切除术和 GT 构建治疗癌症的患者前瞻性保存数据库中的数据。相关结果是可行性、ICGA 并发症以及 ICGA 对 AL 的影响。
确定了 266 例符合纳入标准的连续 IL 患者。将 115 例接受围手术期 ICGA 治疗的患者与一组按标准护理进行手术的对照组进行比较。所有 115 例手术均可行且安全地进行了 ICGA 灌注评估，提示 56/115（48.7%）例存在 tip 灌注不良，对此进行了额外的切除。总体 AL 发生率为 16%（43/266），12%（33/266）需要内镜或手术干预，6%（17/266）需要 ICU 支持。单变量和多变量分析显示，ICGA 与 AL 风险无关（ICGA：14.8%比非 ICGA：17.2%，p=0.62）。然而，GT 的 ICGA 灌注不良预测 AL 发生率更高，尽管对 tip 进行了额外切除（ICGA 灌注不良：19.6%比 ICG 灌注良好：10.2%，p=0.19）。
ICGA 安全可行，但并未降低 AL 发生率。在围手术期存在缺血时，ICGA 的解释和必要的操作尚待确定。需要前瞻性随机试验来分析其在食管手术中对 AL 的益处。
BC-09216。
