He Wenwu, Li Zhiyu, Deng Xuyang, Zheng Kai, Wang Chenghao, Peng Lin, Han Yongtao, Leng Xuefeng, Zhou Qiuxi
Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.
Department of Thoracic Surgery, The People's Hospital of Leshan, Leshan, China.
Surg Endosc. 2025 Aug 20. doi: 10.1007/s00464-025-12093-6.
Indocyanine green (ICG) can help surgeons identify the blood perfusion distribution of the gastric conduit. The aim of our study is to utilize ICG fluorescence for quantitative assessment of blood perfusion at the anastomotic site to minimize postoperative anastomotic leakage.
Patients who underwent McKeown esophagectomy with esophageal squamous cell carcinoma between August 1, 2019, and July 31, 2021, were enrolled in the study and randomly assigned to two groups. The intervention group received ICG fluorescence-guided anastomotic site selection. ICG fluorescence was used to quantitatively assess the blood perfusion fluorescence threshold at the anastomotic site in the gastric conduit, and anastomosis was performed only at sites where the fluorescence threshold exceeded the established threshold. In the control group, anastomosis was conducted at the visually evaluated site determined by the surgeon's experience.
45 eligible patients were assigned to the intervention group, and 47 patients were allocated to the control group, respectively. Anastomotic leakage within 30 days occurred in 6.7% (3/45) of the intervention group and in 21.3% (10/47) of the control group (p = 0.021). Additionally, no differences were observed in anastomotic stenosis within 90 days, overall survival time or in the effect of neoadjuvant therapy on anastomotic leakage.
ICG fluorescence can identify the areas with good perfusion in the gastric conduit and significantly reduce the occurrence of anastomotic leakage following esophagectomy.
ClinicalTrials.gov Identifier: NCT04229524.
吲哚菁绿（ICG）可帮助外科医生识别胃管道的血液灌注分布。本研究的目的是利用ICG荧光对吻合口部位的血液灌注进行定量评估，以尽量减少术后吻合口漏。
选取2019年8月1日至2021年7月31日期间接受McKeown食管癌切除术的食管鳞状细胞癌患者纳入研究，并随机分为两组。干预组接受ICG荧光引导下的吻合口部位选择。使用ICG荧光定量评估胃管道吻合口部位的血液灌注荧光阈值，仅在荧光阈值超过既定阈值的部位进行吻合。对照组在由外科医生经验确定的视觉评估部位进行吻合。
分别有45例符合条件的患者被分配到干预组，47例患者被分配到对照组。干预组30天内吻合口漏发生率为6.7%（3/45），对照组为21.3%（10/47）（p = 0.021）。此外，90天内吻合口狭窄、总生存时间或新辅助治疗对吻合口漏的影响方面未观察到差异。
ICG荧光可识别胃管道中灌注良好的区域，并显著降低食管癌切除术后吻合口漏的发生率。
ClinicalTrials.gov标识符：NCT04229524。
