Perfusion assessment by fluorescence time curves in esophagectomy with gastric conduit reconstruction: a prospective clinical study.

Autor: Joosten JJ; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands., Slooter MD; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands., van den Elzen RM; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Biomedical Engineering, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands., Bloemen PR; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Biomedical Engineering, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands., Gisbertz SS; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands., Eshuis WJ; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands., Daams F; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., de Bruin DM; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Biomedical Engineering, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands., van Berge Henegouwen MI; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. m.i.vanbergehenegouwen@amsterdamumc.nl.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands. m.i.vanbergehenegouwen@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Aug; Vol. 37 (8), pp. 6343-6352. Date of Electronic Publication: 2023 May 19.
DOI: 10.1007/s00464-023-10107-9
Abstrakt: Background: Intraoperative perfusion assessment with indocyanine green fluorescence angiography (ICG-FA) may reduce postoperative anastomotic leakage rates after esophagectomy with gastric conduit reconstruction. This study evaluated quantitative parameters derived from fluorescence time curves to determine a threshold for adequate perfusion and predict postoperative anastomotic complications.
Methods: This prospective cohort study included consecutive patients who underwent FA-guided esophagectomy with gastric conduit reconstruction between August 2020 and February 2022. After intravenous bolus injection of 0.05-mg/kg ICG, fluorescence intensity was registered over time by PINPOINT camera (Stryker, USA). Fluorescent angiograms were quantitatively analyzed at a region of interest of 1 cm diameter at the anastomotic site on the conduit using tailor-made software. Extracted fluorescence parameters were both inflow (T 0 , T max , F max , slope, Time-to-peak) as outflow parameters (T 90% and T 80% ). Anastomotic complications including anastomotic leakage (AL) and strictures were documented. Fluorescence parameters in patients with AL were compared to those without AL.
Results: One hundred and three patients (81 male, 65.7 ± 9.9 years) were included, the majority of whom (88%) underwent an Ivor Lewis procedure. AL occurred in 19% of patients (n = 20/103). Both time to peak as T max were significantly longer for the AL group in comparison to the non-AL group (39 s vs. 26 s, p = 0.04 and 65 vs. 51 s, p = 0.03, respectively). Slope was 1.0 (IQR 0.3-2.5) and 1.7 (IQR 1.0-3.0) for the AL and non-AL group (p = 0.11). Outflow was longer in the AL group, although not significantly, T 90% 30 versus 15 s, respectively, p = 0.20). Univariate analysis indicated that T max might be predictive for AL, although not reaching significance (p = 0.10, area under the curve 0.71) and a cut-off value of 97 s was derived, with a specificity of 92%.
Conclusion: This study demonstrated quantitative parameters and identified a fluorescent threshold which could be used for intraoperative decision-making and to identify high-risk patients for anastomotic leakage during esophagectomy with gastric conduit reconstruction. A significant predictive value remains to be determined in future studies.
(© 2023. The Author(s).)
Databáze: MEDLINE
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