The Near-Infrared Visualization and Preemptive Ligation of the Thoracic Duct Effectively Reduce the Chyle Leak Incidence After Minimally Invasive Esophagectomy.

Autor:	Puccetti F; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Vita-Salute San Raffaele University, School of Medicine, Milan, Italy., Cinelli L; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy., Barbieri LA; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy., Socci D; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy., Clelia DS; University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy., De Cobelli F; Vita-Salute San Raffaele University, School of Medicine, Milan, Italy.; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Elmore U; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Vita-Salute San Raffaele University, School of Medicine, Milan, Italy., Rosati R; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Vita-Salute San Raffaele University, School of Medicine, Milan, Italy.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Nov 01; Vol. 280 (5), pp. 780-787. Date of Electronic Publication: 2024 Aug 13.
DOI:	10.1097/SLA.0000000000006490
Abstrakt:	Objective: The aim of the present study is to assess the effectiveness of indocyanine-green (ICG)-guided lymphography (ICG-Lg) in reducing the incidence of chyle leak (CL) after esophagectomy. Background: Chylothorax may severely impact esophageal cancer surgery, and the pre-emptive ligation of the thoracic duct (TD) is the most widespread control of this complication. Intraoperative ICG-Lg has been recently embedded in minimally invasive esophagectomy to facilitate TD detection and pre-emptive ligation. Methods: This retrospective analysis included consecutive patients who underwent minimally invasive Ivor Lewis esophagectomy for cancer at a tertiary referral center between January 2018 and August 2023. Patients were routinely submitted to extended lymphadenectomy with TD ligation and removal. All patients treated after January 2021 underwent ICG-Lg for TD identification and ligation (ICG group) and compared with the previous series (no-ICG group). The primary outcome was the incidence of postoperative CL, while univariate and backward stepwise multivariate logistic regression models were performed to identify associated factors. Results: After including 320 patients, 151 (ICG group) were submitted to ICG-Lg before the pre-emptive TD ligation. Both groups presented similar characteristics, except for neoadjuvant therapy ( P <0.001) and preoperative comorbidities ( P =0.045). Intraoperative ICG-Lg significantly reduced the incidence of postoperative CL (11.8% vs 4.6%, P =0.026) and was significantly associated with shorter median length of hospital stay (13 vs 9 d, P =0.006). However, CL after ICG-Lg was more likely to require repairing reoperation ( P =0.050). Conclusions: Intraoperative ICG-Lg demonstrated significantly lower rates of CL after total minimally invasive esophagectomy and, therefore, it should be routinely embedded in the standardized surgical technique of high-volume centers for esophageal cancer. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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