Risk Reduction of Severe Anastomotic Leakage by Evaluation of Blood Perfusion Using Indocyanine Green After Minimally Invasive Esophagectomy Followed by Narrow Gastric Tube Reconstruction.
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引用次数: 0
Abstract
Background: Anastomotic leakage (AL) is a major complication after esophagectomy and gastric tube reconstruction. This retrospective study aims to reveal the factors in prevention of AL and in reduction of its severity.
Methods: Enrolled in this study were the 183 patients diagnosed with esophageal cancer who underwent minimally invasive esophagectomy followed by narrow gastric tube reconstruction at Wakayama Medical University Hospital between January 2018 and March 2023. Evaluation of blood perfusion using indocyanine green began in September 2020.
Results: AL occurred in 42 patients (22%) and did not occur in 141 patients (78%). Patient characteristics were not significantly different between patients with and without AL. Evaluation of blood perfusion of the gastric tube was performed in 69 of the 183 patients (37.7%), and after its introduction the rates of AL decreased from 28.0% to 14.4%. Blood perfusion was less evaluated in the AL group than in the non-AL group (23.8% vs. 41.8%, P=0.034). Multivariate analysis demonstrated that non-evaluation of blood perfusion using indocyanine green (odds=3.115) was an independent risk factor for AL. For the patients with AL, active interventions (eg, tube insertion into the gastric tube through the nose or fistula, embolization of cyanoacrylate) were performed significantly more often in the group without evaluation of blood perfusion than in the group with evaluation. Without evaluation of blood perfusion, there was significantly longer time from onset to resumption of diet and significantly longer postoperative hospital stays.
Conclusions: Evaluation of qualitative blood perfusion can lead to both risk reduction and prevention of severe AL after narrow gastric tube reconstruction for esophageal cancer.
期刊介绍:
Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.