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The evaluation of the gastric tube blood flow by indocyanine green fluorescence angiography during esophagectomy: a multicenter prospective study

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Abstract

Objective

We determined the anastomotic site during gastric tube reconstruction in esophagectomy according to the "90-to 60-s rule" using indocyanine green (ICG) fluorescence angiography. We evaluated its safety and efficacy in a prospective multicenter setting.

Methods

We enrolled 129 patients who underwent subtotal esophagectomy for esophageal cancer. ICG fluorescence angiography was performed after making a wide gastric tube, and the time from the initial enhancement of the right gastroepiploic artery to the tip of the gastric tube was used as a parameter. Esophago-gastro anastomosis was made at the area that was enhanced within 90 s (preferably within 60 s). The enhancement time and the incidence of anastomotic leakage were compared.

Results

In all cases, anastomosis was made at the site enhanced within 90 s. Anastomotic leakage was found in only 4 (3.1%) of 129 cases; specifically, it was detected in 3 (2.4%) of 126 cases whose anastomotic site was enhanced within 60 s and in 1 (33.3%) of 3 cases where the enhancement time exceeded 60 s (p = 0.09).

Conclusions

Determining the anastomotic site using the 90-to 60-s rule with ICG imaging in gastric tube reconstruction helps reduce the rate of anastomotic leakage.

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Acknowledgements

All authors declare that they have no funding.

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All authors declare that they have no funding/support.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Kazuya Yamaguchi, Akihiro Hoshino, Yutaka Tokairin, Kenro Kawada, Yasuaki Nakajima & Yusuke Kinugasa

  2. Department of Digestive Tract and General Surgery, Saitama Medical Center, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan

    Youichi Kumagai & Hideyuki Ishida

  3. Department of Surgery, Ota Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama-shi, Fukushima, 963-8558, Japan

    Katsumasa Saito & Shigeru Yamazaki

Authors
  1. Kazuya Yamaguchi
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  2. Youichi Kumagai
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  3. Katsumasa Saito
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  4. Akihiro Hoshino
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  5. Yutaka Tokairin
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  6. Kenro Kawada
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  7. Yasuaki Nakajima
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  8. Shigeru Yamazaki
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  9. Hideyuki Ishida
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  10. Yusuke Kinugasa
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Correspondence to Kazuya Yamaguchi.

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Yamaguchi, K., Kumagai, Y., Saito, K. et al. The evaluation of the gastric tube blood flow by indocyanine green fluorescence angiography during esophagectomy: a multicenter prospective study. Gen Thorac Cardiovasc Surg 69, 1118–1124 (2021). https://doi.org/10.1007/s11748-021-01640-2

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  • DOI: https://doi.org/10.1007/s11748-021-01640-2

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