Quantitative Assessment of Blood Flow in the Gastric Conduit With Thermal Imaging for Esophageal Reconstruction.
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
/ methods
Anastomotic Leak
/ diagnosis
Esophageal Neoplasms
/ surgery
Esophagectomy
/ methods
Esophagoplasty
/ methods
Female
Fluorescein Angiography
/ methods
Follow-Up Studies
Humans
Intraoperative Period
Male
Middle Aged
Regional Blood Flow
/ physiology
Reproducibility of Results
Retrospective Studies
Stomach
/ blood supply
Thermography
/ methods
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
3
1
2019
medline:
25
6
2020
entrez:
3
1
2019
Statut:
ppublish
Résumé
The study's primary aim was to evaluate the effectiveness of thermal imaging (TI) and its secondary aim was to compare TI and indocyanine green (ICG) fluorescence angiography, with respect to the evaluation of the viability of the gastric conduit. The optimal method for evaluating perfusion in the gastric conduit for esophageal reconstruction has not been established. We reviewed the prospectively collected data of 263 patients who had undergone esophagectomy with gastric conduit reconstruction. TI was used in all patients. ICG fluorescence was concomitantly used in 24 patients to aid comparison with TI. A cut-off value of the anastomotic viability index (AVI) was calculated using the receiver operating characteristic curve in TI. Anastomotic leak was significantly less common in patients with AVI > 0.61 compared with those with AVI ≤ 0.61 (2% vs 28%, P< 0.001). Microvascular augmentation was performed in 20 patients with a low AVI score and/or preoperative chemoradiotherapy. Overall ability was comparable between TI and ICG fluorescence regarding the qualitative evaluation of the gastric conduit. However, TI was superior in the quantitative assessment of viability. TI could delineate the area of good perfusion in the gastric conduit for esophageal reconstruction, which can help identify patients at high risk of anastomotic leak.
Sections du résumé
OBJECTIVE
The study's primary aim was to evaluate the effectiveness of thermal imaging (TI) and its secondary aim was to compare TI and indocyanine green (ICG) fluorescence angiography, with respect to the evaluation of the viability of the gastric conduit.
SUMMARY BACKGROUND DATA
The optimal method for evaluating perfusion in the gastric conduit for esophageal reconstruction has not been established.
METHODS
We reviewed the prospectively collected data of 263 patients who had undergone esophagectomy with gastric conduit reconstruction. TI was used in all patients. ICG fluorescence was concomitantly used in 24 patients to aid comparison with TI. A cut-off value of the anastomotic viability index (AVI) was calculated using the receiver operating characteristic curve in TI.
RESULTS
Anastomotic leak was significantly less common in patients with AVI > 0.61 compared with those with AVI ≤ 0.61 (2% vs 28%, P< 0.001). Microvascular augmentation was performed in 20 patients with a low AVI score and/or preoperative chemoradiotherapy. Overall ability was comparable between TI and ICG fluorescence regarding the qualitative evaluation of the gastric conduit. However, TI was superior in the quantitative assessment of viability.
CONCLUSIONS
TI could delineate the area of good perfusion in the gastric conduit for esophageal reconstruction, which can help identify patients at high risk of anastomotic leak.
Identifiants
pubmed: 30601260
doi: 10.1097/SLA.0000000000003169
pii: 00000658-202006000-00018
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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