title: Blood flow speed of the gastric conduit assessed by indocyanine green fluorescence: New predictive evaluation of anastomotic leakage after esophagectomy.
abstract: Anastomotic leakage is considered as an independent risk factor for postoperative mortality after esophagectomy, and an insufficient blood flow in the reconstructed conduit may be a risk factor of anastomotic leakage. We investigated the clinical significance of blood flow visualization by indocyanine green (ICG) fluorescence in the gastric conduit as a means of predicting the leakage of esophagogastric anastomosis after esophagectomy.Forty patients who underwent an esophagectomy with gastric conduit reconstruction were prospectively investigated. ICG fluorescence imaging of the gastric conduit was detected by a near-infrared camera system during esophagectomy and correlated with clinical parameters or surgical outcomes.In 25 patients, the flow speed of ICG fluorescence in the gastric conduit wall was simultaneous with that of the greater curvature vessels (simultaneous group), whereas in 15 patients this was slower than that of the greater curvature vessels (delayed group). The reduced speed of ICG fluorescence stream in the gastric conduit wall was associated with intraoperative blood loss (P = 0.008). Although anastomotic leakage was not found in the simultaneous group, it occurred in 7 patients of the delayed group (P < 0.001). A flow speed of ICG fluorescence in the gastric conduit wall of 1.76 cm/s or less was determined by a receiver operating characteristic (ROC) curve, identified as a significant independent predictor of anastomotic leakage after esophagectomy (P = 0.004).This preliminary study demonstrates that intraoperative evaluation of blood flow speed by ICG fluorescence in the gastric conduit wall is a useful means to predict the risk of anastomotic leakage after esophagectomy.
authors.affiliation: Division of Esophageal Surgery Division of Colorectal Surgery, Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Koyanagi
authors.forename: Soji
authors.initials: S
authors.lastname: Ozawa
authors.forename: Junya
authors.initials: J
authors.lastname: Oguma
authors.forename: Akihito
authors.initials: A
authors.lastname: Kazuno
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Yamato
authors.initials: Y
authors.lastname: Ninomiya
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ochiai
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tachimori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D019265:Spectroscopy, Near-Infrared; D013270:Stomach / Q000098:blood supply* / Q000601:surgery*
chemical_list: D007208:Indocyanine Green