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Open Access 01-12-2022 | Esophageal Cancer | Research

Circular stapling anastomosis with indocyanine green fluorescence imaging for cervical esophagogastric anastomosis after thoracoscopic esophagectomy: a propensity score-matched analysis

Authors: Yuji Shishido, Tomoyuki Matsunaga, Masahiro Makinoya, Wataru Miyauchi, Shota Shimizu, Kozo Miyatani, Chihiro Uejima, Masaki Morimoto, Yuki Murakami, Takehiko Hanaki, Kyoichi Kihara, Manabu Yamamoto, Naruo Tokuyasu, Shuichi Takano, Teruhisa Sakamoto, Hiroaki Saito, Toshimichi Hasegawa, Yoshiyuki Fujiwara

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

Thoracoscopic esophagectomy has been extensively used worldwide as a curative surgery for patients with esophageal cancer; however, complications such as anastomotic leakage and stenosis remain a major concern. Therefore, the objective of this study was to evaluate the efficacy of circular stapling anastomosis with indocyanine green (ICG) fluorescence imaging, which was standardized for cervical esophagogastric anastomosis after thoracoscopic esophagectomy.

Methods

Altogether, 121 patients with esophageal cancer who underwent thoracoscopic esophagectomy with radical lymph node dissection and cervical esophagogastric anastomosis from November 2009 to December 2020 at Tottori University Hospital were enrolled in this study. Patients who underwent surgery before the anastomotic method was standardized were included in the classical group (n = 82) and patients who underwent surgery after the anastomotic method was standardized were included in the ICG circular group (n = 39). The short-term postoperative outcomes, including anastomotic complications, were compared between the two groups using propensity-matched analysis and the risk factors for anastomotic leakage were evaluated using logistic regression analyses.

Results

Of the 121 patients, 33 were included in each group after propensity score matching. The clinicopathological characteristics of patients did not differ between the two groups after propensity score matching. In terms of perioperative outcomes, a significantly higher proportion of patients who underwent surgery using the laparoscopic approach (P < 0.001) and narrow gastric tube (P = 0.003), as well as those who had a lower volume of blood loss (P = 0.009) in the ICG circular group were observed after matching. Moreover, the ICG circular group had a significantly lower incidence of anastomotic leakage (39% vs. 9%, P = 0.004) and anastomotic stenosis (46% vs. 21%, P = 0.037) and a shorter postoperative hospital stay (30 vs. 20 days, P < 0.001) than the classical group. According to the multivariate analysis, the anastomotic method was an independent risk factor for anastomotic leakage after thoracoscopic esophagectomy (P = 0.013).

Conclusions

Circular stapling anastomosis with ICG fluorescence imaging is effective in reducing complications such as anastomotic leakage and stenosis.

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Title: Circular stapling anastomosis with indocyanine green fluorescence imaging for cervical esophagogastric anastomosis after thoracoscopic esophagectomy: a propensity score-matched analysis
Authors: Yuji Shishido
Tomoyuki Matsunaga
Masahiro Makinoya
Wataru Miyauchi
Shota Shimizu
Kozo Miyatani
Chihiro Uejima
Masaki Morimoto
Yuki Murakami
Takehiko Hanaki
Kyoichi Kihara
Manabu Yamamoto
Naruo Tokuyasu
Shuichi Takano
Teruhisa Sakamoto
Hiroaki Saito
Toshimichi Hasegawa
Yoshiyuki Fujiwara
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Esophageal Cancer
Esophagus Resection
Esophageal Cancer
Esophagus Resection
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01602-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Circular stapling anastomosis with indocyanine green fluorescence imaging for cervical esophagogastric anastomosis after thoracoscopic esophagectomy: a propensity score-matched analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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