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World Journal of Surgery

Published in:

01-01-2014

Hemodynamics of the Reconstructed Gastric Tube During Esophagectomy: Assessment of Outcomes with Indocyanine Green Fluorescence

Authors: Youichi Kumagai, Toru Ishiguro, Norihiro Haga, Koki Kuwabara, Tatsuyuki Kawano, Hideyuki Ishida

Published in: World Journal of Surgery | Issue 1/2014

Abstract

Background

Construction of a gastric tube that is well perfused with blood during esophagectomy is the most important factor in avoiding anastomotic leakage. We clarified the hemodynamics of the reconstructed gastric tube with indocyanine green (ICG) fluorescence.

Methods

In 20 patients undergoing gastric tube reconstruction during esophagectomy, we evaluated blood flow in the gastric tube with ICG fluorescence imaging. We divided the patients into two groups according to the quality of blood flow to the gastric tube—“good” (n = 9) and “sparse or absent” (n = 11)—based on visual assessment of the anastomosis of the right and left gastroepiploic vessels. We measured the time from initial enhancement of the root of the right gastroepiploic artery until enhancement of the most cranial branch of the left gastroepiploic artery and tip of the gastric tube.

Results

The gastric tube was divisible into three zones according to the dominant arteries present in the greater curvature under ICG fluorescence. The left gastroepiploic artery was enhanced in a direction opposite that of physiological blood flow in all cases. The median period from initial enhancement of the root of the right gastroepiploic artery to the most cranial branch of the left gastroepiploic artery until perfusion up to the tip of the gastric tube did not differ significantly between the “good” and the “sparse or absent” groups (P = 0.24, 0.68)

Conclusions

It is essential to preserve the whole vessel arcade of the greater curvature to achieve good blood perfusion in the gastric tube. The ICG fluorescence method has potential usefulness for evaluation of blood flow in the gastric tube.

Wormuth JK, Heitmiller RF (2006) Esophageal conduit necrosis. Thorac Surg Clin 16:11–22PubMedCrossRef

Ando N, Ozawa S, Kitagawa Y et al (2000) Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 232:225–232PubMedCrossRef

Orringer MB, Marshall B, Iannettony MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–400PubMedCrossRef

Peracchia A, Bardini R, Ruol A et al (1988) Esophageal anastomotic leak. A prospective study of predisposing factors. J Thorac Cardiovasc Surg 95:685–691PubMed

Briel JW, Tamhankar AP, Hagen JA et al (2004) Prevalence and risk factors for ischemia, leak and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 198:536–542PubMedCrossRef

Moorehead RJ, Wong J (1990) Gangrene in esophageal substitute after resection and bypass procedures for carcinoma of the esophagus. Hepatogastroenterology 37:364–367PubMed

Akiyama H, Miyazono H, Tsurumaru M et al (1978) Use of the stomach as an esophageal substitute. Ann Surg 188:606–610PubMedCrossRef

Miyazaki T, Kuwano H, Kato H et al (2002) Predictive value of blood flow in the gastric tube in anastomotic insufficiency after thoracic esophagectomy. World J Surg 26:1319–1323. doi:10.1007/s00268-002-6366-9 PubMedCrossRef

Schilling MK, Mettler D, Redaelli C et al (1997) Circulatory and anatomic differences among experimental gastric tubes as esophageal replacement. World J Surg 21:992–997. doi:10.1007/s002689900338 PubMedCrossRef

10.

Tsekov C, Belyaev O, Tcholakov O et al (2006) Intraoperative Doppler assessment of gastric tube perfusion in esophagogastroplasty. J Surg Res 132:98–103PubMedCrossRef

11.

Ikeda Y, Niimi M, Kan S et al (2001) Clinical significance of tissue blood flow during esophagectomy by laser Doppler flowmetry. J Thorac Cardiovasc Surg 122:1101–1106PubMedCrossRef

12.

Awano T, Sakatani K, Yokose N et al (2010) Intraoperative EC-IC bypass blood flow assessment with indocyanine green angiography in moyamoya and non-moyamoya ischemic stroke. World Neurosurg 73:668–674PubMedCrossRef

13.

Kang Y, Lee J, Kwon K et al (2010) Dynamic fluorescence imaging of indocyanine green for reliable and sensitive diagnosis of peripheral vascular insufficiency. Microvasc Res 80:552–555PubMedCrossRef

14.

Yamamoto M, Sasaguri S, Sato T (2011) Assessing intraoperative blood flow in cardiovascular surgery. Surg Today 41:1467–1474PubMedCrossRef

15.

Unno N, Suzuki M, Yamamoto N et al (2008) Indocyanine green fluorescence angiography for intraoperative assessment of blood flow: a feasibility study. Eur J Vasc Endovasc Surg 35(2):205–207PubMedCrossRef

16.

Giunta RE, Holzbach T, Taskov C et al (2005) Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg 58:695–701PubMedCrossRef

17.

Kamp MA, Slotty P, Turowski B et al (2012) Microscopic-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: first experience in 30 patients. Neurosurgery 70:65–74PubMedCrossRef

18.

Holm C, Mayr E, Höfter E et al (2002) Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55:635–644PubMedCrossRef

19.

Saito T, Yano M, Motoori M et al (2012) Subtotal gastrectomy for gastric tube cancer after esophagectomy: a safe procedure preserving the proximal part of gastric tube based on intraoperative ICG blood flow evaluation. J Surg Oncol 106:107–110PubMedCrossRef

20.

Shimada Y, Okamura T, Nagata T et al (2011) Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy. Esophagus 8:259–266PubMedCentralPubMedCrossRef

21.

Ishiguro T, Kumagai Y, Ono T et al (2012) Usefulness of indocyanine green angiography for evaluation of blood supply in a reconstructed gastric tube during esophagectomy. Int Surg 97:340–344PubMedCrossRef

22.

Matsuda T, Kaneda K, Takamatsu M et al (2010) Reliable preparation of the gastric tube for cervical esophagogastrostomy after esophagectomy for esophageal cancer. Am J Surg 199:61–64CrossRef

23.

Kono K, Sugai H, Omata H et al (2007) Transient bloodletting of the short gastric vein in the reconstructed gastric tube improves gastric microcirculation during esophagectomy. World J Surg 31:780–784. doi:10.1016/j.surg.2009 PubMedCrossRef

24.

Murakami M, Sugiyama A, Ikegami T et al (1999) Additional microvascular anastomosis in reconstruction after total esophagectomy for cervical esophageal carcinoma. Am J Surg 178:263–266PubMedCrossRef

25.

Yoshimi F, Asato Y, Ikeda S et al (2006) Using the supercharge technique to additionally revascularize the gastric tube after subtotal esophagectomy for esophageal cancer. Am J Surg 191:284–287PubMedCrossRef

26.

Sekido M, Yamamoto Y, Minakawa H et al (2003) Use of the “supercharge” technique in esophageal and pharyngeal reconstruction to augment microvascular blood flow. Surgery 134:420–424PubMedCrossRef

27.

Fujisawa Y, Nakamura Y, Kawachi Y et al (2012) Indocyanine green fluorescence-navigated sentinel node biopsy showed higher sensitivity than the radioisotope or blue dye method, which may help to reduce false-negative cases in skin cancer. J Surg Oncol 106:41–45PubMedCrossRef

28.

Aoyama K, Kamio T, Ohchi T et al (2011) Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green. World J Surg Oncol 9:157PubMedCentralPubMedCrossRef

Title: Hemodynamics of the Reconstructed Gastric Tube During Esophagectomy: Assessment of Outcomes with Indocyanine Green Fluorescence
Authors: Youichi Kumagai
Toru Ishiguro
Norihiro Haga
Koki Kuwabara
Tatsuyuki Kawano
Hideyuki Ishida
Publication date: 01-01-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 1/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2237-9

At a glance: The STEP trials

Springer Medicine

Hemodynamics of the Reconstructed Gastric Tube During Esophagectomy: Assessment of Outcomes with Indocyanine Green Fluorescence

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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