Quantitative change of perfusion in gastric tube reconstruction by sidestream dark field microscopy (SDF) after esophagectomy, a prospective in-vivo cohort study.

Autor: Jansen SM; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering & Physics, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands. Electronic address: s.m.jansen@amc.uva.nl., de Bruin DM; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering & Physics, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Department of Urology, Amsterdam, The Netherlands., van Berge Henegouwen MI; Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands., Bloemen PR; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering & Physics, Cancer Center Amsterdam, Amsterdam, The Netherlands., Strackee SD; Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive & Hand Surgery, Amsterdam, The Netherlands., Veelo DP; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Cancer Center Amsterdam, Amsterdam, The Netherlands., van Leeuwen TG; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam Cardiovascular Sciences, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands., Gisbertz SS; Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2021 May; Vol. 47 (5), pp. 1034-1041. Date of Electronic Publication: 2020 Sep 13.
DOI: 10.1016/j.ejso.2020.09.006
Abstrakt: Background: Anastomotic leakage is one of the most severe complications in patients undergoing esophagectomy with gastric tube reconstruction. Transection of the left gastric and gastro-epiploic artery and vein results in compromised perfusion which is seen as the major contributing factor for anastomotic dehiscence. The main objective of this prospective, observational, in-vivo pilot study is to microscopically evaluate gastric tube perfusion with Sidestream Darkfield Microscopy (SDF).
Methods: Intra-operative microscopic images of gastric-microcirculation were obtained with SDF directly after reconstruction in 22 patients. Quantitative perfusion related parameters were: velocity, Microvascular Flow Index(MFI), Total Vessel Density(TVD), Perfusion Vessel Density(PVD), Proportion of Perfused Vessels(PPV) and De Backer Score(DBS). Dedicated software was used to assess parameters predictive for compromised perfusion.
Results: SDF was feasible to accurately visualize and evaluate microcirculation in all patients. Velocity(μm/sec) was significantly decreased towards the fundus (p = 0.001). MFI, PVD and PVD were decreased distal of the watershed - between the right and left gastro-epiploic artery and vein - and in the fundus, compared to the base of the gastric tube(p = 0.0002). No differences in TVD and DBS were observed; because of vessel-dilation in the fundus-area. This suggests that venous congestion results in comprised inflow of oxygen rich blood and plays a role in the development of ischaemia.
Conclusion: We present quantitative perfusion imaging with SDF of the gastric tube. Velocity, MFI, TVD and PPV are accurate parameters to observe perfusion decrease. Also, venous congestion is visible in the fundus, suggesting an important role in the development of ischaemia. These parameters could allow early risk stratification, and, potentially, can accomplish a reduction in anastomotic leakage.
Competing Interests: Declaration of competing interest The authors have no conflict of interests.
(Copyright © 2020. Published by Elsevier Ltd.)
Databáze: MEDLINE
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