Evaluation of Blood Flow with Indocyanine Green-Guided Imaging to Determine Optimal Site for Gastric Conduit Anastomosis to Prevent Anastomotic Leak after Esophagectomy

摘要

Anastomotic leak (AL) after esophagectomy for esophageal cancer remains an important cause of prolonged hospitalization and impaired quality of life. Previous reports have shown that the incidence of AL is 5 to 25 per cent after esophagectomy. While several risk factors for AL have been identified, one of the most important risk factors is poor blood supply to the proximal part of the gastric conduit. Hence, techniques that identify regions of inadequate blood supply may help decrease the risk of AL after esophagectomy. Indocyanine green (ICG) has long been used to evaluate vascular beds in various tissues, particularly the eye, heart, and liver. After injection into the blood stream, ICG is distributed throughout the circulatory system and can be visualized within tissues. The intensity of florescence can be used to evaluate the vascular supply of tissues. Recently, ICG fluorescein imaging (ICGFI) has been used to evaluate blood and lymphatic vessels, for example, in vascular surgery, in gastrointestinal anastomosis, and in sentinel lymph node navigation.3 This method has been shown to be an accurate tool for assessing microperfusion and has been associated with improved anastomotic healing after colorectal surgery.4 While similar results might be expected after esophageal cancer surgery, as this method can be used to evaluate blood flow in the gastric conduit, there are no reports detailing this. The aim of the present study is to establish ICGFI as a method to evaluate blood flow and thereby facilitate the optimal determination of gastric conduit anastomotic sites to prevent AL after esophagectomy.