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Assessment of the blood supply using the indocyanine green fluorescence method and postoperative endoscopic evaluation of anastomosis of the gastric tube during esophagectomy

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Abstract

Background

Postoperative anastomotic leakage is a severe complication after gastric tube reconstruction during esophagectomy. The aim of this study was to evaluate the usefulness of postoperative endoscopic assessment of anastomosis and its correlation with intraoperative indocyanine green (ICG) fluorescence assessment of the gastric tube.

Methods

We retrospectively reviewed 72 consecutive patients who underwent gastric tube reconstruction using the ICG fluorescence method during esophagectomy. Forty-six patients underwent the ICG line-marking method (LMM group; ICG before gastric tube creation). The other 26 underwent the conventional procedure and comprised the control group (ICG after gastric tube creation). Postoperative endoscopic assessment (PEA) of anastomosis was performed 7 days after surgery and results were classified as follows: grade 1 (normal or partial white coat), grade 2 (ulcer comprising less than half the circumference), and grade 3 (ulcer comprising more than half the circumference).

Results

Anastomotic leakage occurred in 7 of 72 patients (9.7%). The incidence of anastomotic leakage in the LMM group was tended to be lower than those in the control group (6.5% vs. 15.4%; P = 0.244). Of the 40 patients who underwent PEA, 3 (7.5%) had leakage. PEA grading was significantly associated with anastomotic leakage (P < 0.001). Better intraoperative ICG assessment was significantly associated with better endoscopic assessment grade (P = 0.041).

Conclusion

Intraoperative ICG assessment of the gastric tube was associated with PEA grading on anastomosis during esophagectomy.

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Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi, 783-8505, Japan

    Hiroyuki Kitagawa, Tsutomu Namikawa, Jun Iwabu, Kazune Fujisawa, Sunao Uemura, Sachi Tsuda & Kazuhiro Hanazaki

Authors
  1. Hiroyuki Kitagawa
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  2. Tsutomu Namikawa
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  3. Jun Iwabu
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  4. Kazune Fujisawa
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  5. Sunao Uemura
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  6. Sachi Tsuda
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  7. Kazuhiro Hanazaki
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Corresponding author

Correspondence to Tsutomu Namikawa.

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Disclosures

Drs. Hiroyuki Kitagawa, Tsutomu Namikawa, Jun Iwabu, Kazune Fujisawa, Sunao Uemura, Sachi Tsuda, and Kazuhiro Hanazaki have no conflicts of interest or financial ties to disclose.

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Informed consent was obtained from all individual participants included in the study.

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Kitagawa, H., Namikawa, T., Iwabu, J. et al. Assessment of the blood supply using the indocyanine green fluorescence method and postoperative endoscopic evaluation of anastomosis of the gastric tube during esophagectomy. Surg Endosc 32, 1749–1754 (2018). https://doi.org/10.1007/s00464-017-5857-6

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  • DOI: https://doi.org/10.1007/s00464-017-5857-6

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