Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vita-Salute San Raffaele University, School of Medicine, Milan, Italy.
Ann Surg. 2024 Nov 1;280(5):780-787. doi: 10.1097/SLA.0000000000006490. Epub 2024 Aug 13.
The aim of the present study is to assess the effectiveness of indocyanine-green (ICG)-guided lymphography (ICG-Lg) in reducing the incidence of chyle leak (CL) after esophagectomy.
Chylothorax may severely impact esophageal cancer surgery, and the pre-emptive ligation of the thoracic duct (TD) is the most widespread control of this complication. Intraoperative ICG-Lg has been recently embedded in minimally invasive esophagectomy to facilitate TD detection and pre-emptive ligation.
This retrospective analysis included consecutive patients who underwent minimally invasive Ivor Lewis esophagectomy for cancer at a tertiary referral center between January 2018 and August 2023. Patients were routinely submitted to extended lymphadenectomy with TD ligation and removal. All patients treated after January 2021 underwent ICG-Lg for TD identification and ligation (ICG group) and compared with the previous series (no-ICG group). The primary outcome was the incidence of postoperative CL, while univariate and backward stepwise multivariate logistic regression models were performed to identify associated factors.
After including 320 patients, 151 (ICG group) were submitted to ICG-Lg before the pre-emptive TD ligation. Both groups presented similar characteristics, except for neoadjuvant therapy ( P <0.001) and preoperative comorbidities ( P =0.045). Intraoperative ICG-Lg significantly reduced the incidence of postoperative CL (11.8% vs 4.6%, P =0.026) and was significantly associated with shorter median length of hospital stay (13 vs 9 d, P =0.006). However, CL after ICG-Lg was more likely to require repairing reoperation ( P =0.050).
Intraoperative ICG-Lg demonstrated significantly lower rates of CL after total minimally invasive esophagectomy and, therefore, it should be routinely embedded in the standardized surgical technique of high-volume centers for esophageal cancer.
本研究旨在评估吲哚菁绿（ICG）引导的淋巴造影（ICG-Lg）在减少食管癌手术后乳糜漏（CL）发生率方面的有效性。
乳糜胸可能严重影响食管癌手术，预防性结扎胸导管（TD）是控制该并发症最广泛的方法。术中 ICG-Lg 最近已被纳入微创食管切除术，以促进 TD 检测和预防性结扎。
本回顾性分析纳入了 2018 年 1 月至 2023 年 8 月期间在一家三级转诊中心接受微创 Ivor Lewis 食管癌切除术的连续患者。患者常规接受广泛的淋巴结清扫术，同时结扎和切除 TD。所有 2021 年 1 月后接受治疗的患者均接受 ICG-Lg 进行 TD 识别和结扎（ICG 组），并与之前的系列（无 ICG 组）进行比较。主要结局是术后 CL 的发生率，同时进行单变量和逐步后退多变量逻辑回归模型以确定相关因素。
纳入 320 例患者后，其中 151 例（ICG 组）在预防性 TD 结扎前接受了 ICG-Lg。两组患者的特征相似，除了新辅助治疗（ P <0.001）和术前合并症（ P =0.045）。术中 ICG-Lg 显著降低了术后 CL 的发生率（11.8% vs 4.6%， P =0.026），且与中位住院时间更短显著相关（13 天 vs 9 天， P =0.006）。然而，ICG-Lg 后发生的 CL 更有可能需要修复再手术（ P =0.050）。
术中 ICG-Lg 显著降低了全微创食管切除术后 CL 的发生率，因此应常规纳入高容量中心食管癌标准化手术技术中。
