Kazuya Yamaguchi1, Youichi Kumagai2, Katsumasa Saito3, Akihiro Hoshino4, Yutaka Tokairin4, Kenro Kawada4, Yasuaki Nakajima4, Shigeru Yamazaki3, Hideyuki Ishida2, Yusuke Kinugasa4. 1. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. kyama713@gmail.com. 2. Department of Digestive Tract and General Surgery, Saitama Medical Center, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. 3. Department of Surgery, Ota Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama-shi, Fukushima, 963-8558, Japan. 4. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Abstract
OBJECTIVE: We determined the anastomotic site during gastric tube reconstruction in esophagectomy according to the "90-to 60-s rule" using indocyanine green (ICG) fluorescence angiography. We evaluated its safety and efficacy in a prospective multicenter setting. METHODS: We enrolled 129 patients who underwent subtotal esophagectomy for esophageal cancer. ICG fluorescence angiography was performed after making a wide gastric tube, and the time from the initial enhancement of the right gastroepiploic artery to the tip of the gastric tube was used as a parameter. Esophago-gastro anastomosis was made at the area that was enhanced within 90 s (preferably within 60 s). The enhancement time and the incidence of anastomotic leakage were compared. RESULTS: In all cases, anastomosis was made at the site enhanced within 90 s. Anastomotic leakage was found in only 4 (3.1%) of 129 cases; specifically, it was detected in 3 (2.4%) of 126 cases whose anastomotic site was enhanced within 60 s and in 1 (33.3%) of 3 cases where the enhancement time exceeded 60 s (p = 0.09). CONCLUSIONS: Determining the anastomotic site using the 90-to 60-s rule with ICG imaging in gastric tube reconstruction helps reduce the rate of anastomotic leakage.
OBJECTIVE: We determined the anastomotic site during gastric tube reconstruction in esophagectomy according to the "90-to 60-s rule" using indocyanine green (ICG) fluorescence angiography. We evaluated its safety and efficacy in a prospective multicenter setting. METHODS: We enrolled 129 patients who underwent subtotal esophagectomy for esophageal cancer. ICG fluorescence angiography was performed after making a wide gastric tube, and the time from the initial enhancement of the right gastroepiploic artery to the tip of the gastric tube was used as a parameter. Esophago-gastro anastomosis was made at the area that was enhanced within 90 s (preferably within 60 s). The enhancement time and the incidence of anastomotic leakage were compared. RESULTS: In all cases, anastomosis was made at the site enhanced within 90 s. Anastomotic leakage was found in only 4 (3.1%) of 129 cases; specifically, it was detected in 3 (2.4%) of 126 cases whose anastomotic site was enhanced within 60 s and in 1 (33.3%) of 3 cases where the enhancement time exceeded 60 s (p = 0.09). CONCLUSIONS: Determining the anastomotic site using the 90-to 60-s rule with ICG imaging in gastric tube reconstruction helps reduce the rate of anastomotic leakage.
Authors: Y Kumagai; S Hatano; J Sobajima; T Ishiguro; M Fukuchi; K-I Ishibashi; E Mochiki; Ya Nakajima; H Ishida Journal: Dis Esophagus Date: 2018-12-01 Impact factor: 3.429
Authors: Sanne M Jansen; Daniel M de Bruin; Leah S Wilk; Mark I van Berge Henegouwen; Simon D Strackee; Suzanne S Gisbertz; Ed T van Bavel; Ton G van Leeuwen Journal: Life (Basel) Date: 2022-02-08