Skip to main content

A novel imaging technology to assess tissue oxygen saturation and its correlation with indocyanine green in the gastric conduit during thoracic esophagectomy

Abstract

Background

Anastomotic leakage in esophagectomy is a serious complication, and assessing blood perfusion in the conduit can help minimize this risk. Indocyanine green is the most widely used method to assess tissue blood flow; however, this technique has disadvantages. Evaluating tissue oxygen saturation in the gastric conduit during thoracic esophagectomy compared with indocyanine green blood perfusion assessment addresses these disadvantages and can be performed easily and repeatedly.

Methods

This was a prospective study of patients with esophageal cancer who underwent thoracic esophagectomy. Intraoperative tissue oxygen saturation and indocyanine green measurements were obtained to determine the anastomotic site and to compare the correlation between the 2 methods. Tissue oxygen saturation and indocyanine green values were obtained at the tip of the gastric conduit, the demarcation line indicating visible perfusion, and the end of the right gastroepiploic artery.

Results

Fifty-seven patients were enrolled in this study; 3 developed anastomotic leakage, and all 3 underwent robotic thoracic surgery. The tissue oxygen saturation value decreased gradually toward the tip of the conduit, as did congestion, and was significantly decreased at the tip compared with the value at the demarcation line (P = .001). Mean tissue oxygen saturation differed significantly between the leakage and no-leakage groups at the anastomosis site (P = .04). We found a negative correlation between tissue oxygen saturation and indocyanine green values at the end of the right gastroepiploic artery (r = −0.361; P = .03).

Conclusion

Tissue oxygen saturation imaging was useful in determining the anastomotic site and addressed the disadvantages associated with indocyanine green.


Takeo Fujita, MD, PhD, FACSa,*, Kazuma Sato, MD, PhDa, Naoto Fujiwara, MD, PhDa,
Daisuke Kajiyama, MDa, Takashi Shigeno, MDa, Hiroyuki Daiko, MD, PhD, FACSb

a Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
b Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan

DOI: https://doi.org/10.1016/j.surg.2023.10.014

Our Corporate Sponsors

Corporate sponsorships make great communities

Founding and Premier Sponsor

Gold Sponsors

© International Society For Fluorescence Guided Surgery. All Rights Reserved.