Decreased conduit perfusion measured by spectroscopy is associated with anastomotic complications.
BACKGROUND
Gastric conduit ischemia during esophagectomy likely contributes to high anastomotic complication rates, yet we lack a reliable method to assess gastric conduit perfusion. We hypothesize that optical fiber spectroscopy (OFS) can reliably assess conduit perfusion and that the degree of intraoperative gastric ischemia is associated with subsequent anastomotic complications.


METHODS
During esophagectomy, OFS was used to measure oxygen saturation (SaO(2)) and blood volume fraction (BVF) in the distal gastric conduit at baseline and after gastric devascularization, conduit formation, and transposition. The SaO(2) and BVF readings were correlated to clinical outcomes.


RESULTS
The OFS measurements were obtained in 23 patients during esophagectomy, four of whom previously underwent gastric ischemic conditioning. Eight patients developed anastomotic complications. Compared with baseline, conduit creation produced a 29.4% reduction in SaO(2) (p < 0.01), while BVF increased by 28% (p = 0.06). Patients with subsequent anastomotic complications demonstrated a 52.5% decrease in SaO(2) upon conduit creation compared with 15.1% in patients without complications (p = 0.01). Patients who underwent ischemic conditioning did not develop significant changes in SaO(2) (p = 0.72) or BVF (p = 0.5) upon gastric conduit creation.


CONCLUSIONS
Intraoperative OFS demonstrates significant alterations in gastric conduit oxygenation during esophageal replacement, which may be tempered by gastric ischemic conditioning. The degree of intraoperative gastric ischemia resulting from gastric conduit creation is associated with the development of anastomotic complications, suggesting that OFS is useful for assessing changes in conduit oxygenation during esophagectomy. Further studies are needed to refine this technology and investigate the clinical utility of intraoperative conduit oxygenation data.
Department of Surgery, Veterans Affairs Medical Center North Texas Health Care System, Dallas, Texas, USA.
Thai H
TH
Pham
Kyle A
KA
Perry
C Kristian
CK
Enestvedt
Dan
D
Gareau
James P
JP
Dolan
Brett C
BC
Sheppard
Steven L
SL
Jacques
John G
JG
Hunter
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006422:Hemerythrin / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D019194:Ischemic Preconditioning; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000473:pathology / Q000601:surgery; D010100:Oxygen / Q000032:analysis; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D013057:Spectrum Analysis / Q000379:methods*; D013270:Stomach / Q000098:blood supply* / Q000601:surgery*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery
D006422:Hemerythrin; D006454:Hemoglobins; C068346:oxyhemerythrin; C100003:deoxyhemoglobin; D010100:Oxygen