649 EFFECTS OF THE PREPARATION METHOD ON THE ICG FLUORESCENCE BLOOD FLOW IN THE GASTRIC CONDUIT AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kazuo Koyanagi ◽  
Soji Ozawa ◽  
Yamato Ninomiya ◽  
Kentaro Yatabe ◽  
Tadashi Higuchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Esophageal Cancer ◽  
Fluorescence Imaging ◽  
Conventional Method ◽  
Current Method ◽  
Flow Speed ◽  
Gastric Conduit ◽  
Gastric Artery ◽  
Conduit Wall ◽  
Lesser Curvature

Abstract   In this study, we investigated how the blood flow of gastric conduit changed due to the difference in the lesser curvature cut line using ICG fluorescence imaging in patients with esophageal cancer. Methods A total of 193 cases of esophageal cancer surgery with gastric conduit reconstruction were included. (Conventional method) The lesser curvature cut line of the stomach was started from a distance of 5 cm from the pylorus (141 cases). (Current method) Gastric lesser curvature dissection was started from the last branch of the left gastric artery (52 cases). Blood flow of the gastric conduit was measured by the ICG fluorescence imaging, and the correlation between the changes in the gastric conduit and both blood flow and anastomotic failure was examined. Results Median length of the lesser curvature cut line was 10 cm from the pylorus in the current method, which was significantly longer than that in the conventional method (P < 0.001). Congestion at the tip of the gastric conduit were more observed in the conventional method (P = 0.02). The ICG fluorescent blood flow speed in the gastric conduit wall was 2.54 cm/s by the conventional method and 2.82 cm/s by the current method (P = 0.03). There were 23 cases (16.3%) of anastomotic leakage in the conventional method and 4 cases (7.7%) in the current method (P = 0.09). Conclusion By preserving the right gastric artery and vein, improvement of venous return is expected, and it is suggested that blood flow in the gastric conduit wall can be well maintained.

162 IMPACT OF FLOW SPEED OF ICG FLUORESCENCE IN THE GASTRIC CONDUIT AND THORACIC INLET SPACE ON ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
K Koyanagi ◽  
S Ozawa ◽  
Y Ninomiya ◽  
K Yatabe ◽  
T Higuchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Anastomotic Leakage ◽  
Fluorescence Imaging ◽  
Flow Speed ◽  
Gastric Conduit ◽  
Thoracic Inlet ◽  
Speed Reduction ◽  
Clinicopathological Findings ◽  
Conduit Wall ◽  
The Impact

Abstract   We have previously demonstrated that the flow speed of indocyanine green (ICG) fluorescence in the gastric conduit wall could predict anastomotic leakage after esophagectomy. Surround organs via retrosternal route is considered to affect the blood flow in the gastric conduit and anastomotic leakage. In the study, we investigated the impact of the flow speed of ICG fluorescence in the gastric conduit wall and thoracic inlet space on anastomotic leakage after esophagectomy. Methods A total of 142 patients, who underwent esophagectomy with three-field lymph node dissection, simultaneous reconstruction using a gastric conduit, and cervical anastomosis via retrosternal route, were prospectively investigated. Using ICG fluorescence imaging, blood flow speed of the gastric conduit wall was assessed before and after anastomosis (pre speed and post speed (cm/s)) and correlated with clinicopathological findings. Parameters of thoracic inlet space was assessed using CT scan and correlated with blood flow speed of the gastric conduit wall and anastomotic leakage. Results Median pre speed was 2.54 (0.73–6.10) cm/s and median post speed was dropped by 1.77 (0.32–8.67) cm/s. Speed reduction (pre speed—post speed) and speed reduction rate ((pre speed—post speed)/pre speed) were negatively correlated with thoracic inlet area (TIA) (P = 0.004, P = 0.021). Pre speed and post speed of the patients with anastomotic leakage were significantly slower than those of the patients without anastomotic leakage, respectively (P < 0.001 and P = 0.050). In 115 patients with pre speed more than 1.98 cm/s, TIA was significantly associated with anastomotic leakage after esophagectomy (P < 0.001). Conclusion We clearly demonstrated that retrosternal route reduced the blood flow of the gastric conduit wall using ICG fluorescence imaging. Narrow thoracic inlet space might obstruct the blood flow of the gastric conduit wall and cause anastomotic leakage after esophagectomy.

scholarly journals Anastomotic leakage after esophagectomy possibly caused by compression of the gastric conduit behind the sternoclavicular joint: a report of three cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yasunori Kurahashi ◽  
Yudai Hojo ◽  
Tatsuro Nakamura ◽  
Tsutomu Kumamoto ◽  
Yoshinori Ishida ◽  
...  
Keyword(s):  
Blood Flow ◽  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Gastric Wall ◽  
Sternoclavicular Joint ◽  
Gastric Conduit ◽  
Thoracic Inlet ◽  
Indocyanine Green Fluorescence ◽  
Subtotal Esophagectomy ◽  
First Case

Abstract Background The narrowness of the thoracic inlet is often a problem in retrosternal reconstruction after esophagectomy. We report here three cases in which compression of the gastric conduit behind the sternoclavicular joint possibly caused anastomotic leakage. Case presentations The first case was a 71-year-old man who underwent subtotal esophagectomy for upper esophageal cancer followed by retrosternal reconstruction. On postoperative day 2, he developed septic shock and underwent reoperation because of a necrotic gastric conduit. The tip of the conduit above the manubrium was necrotic due to strangulation as a result of compression by the sternoclavicular joint. The second and third cases were a 50-year-old woman and a 71-year-old man who underwent subtotal esophagectomy for middle and lower esophageal cancer, respectively, followed by retrosternal reconstruction. Despite indocyanine green fluorescence imaging indicating adequate blood flow in both cases, the tip of the conduit appeared pale and congested because of compression by the sternoclavicular joint after anastomosis. Postoperatively, these two patients developed anastomotic leakage that was confirmed endoscopically on the ventral side of the gastric wall that had been pale intraoperatively. Conclusions When performing reconstruction using the retrosternal route after esophagectomy, it is important to ensure that compression by the sternoclavicular joint does not have an adverse impact on blood flow at the tip of the gastric conduit.

scholarly journals A safe and simple technique for nasogastric tube insertion in patients with thoracic esophageal cancer surgery

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Noriyuki Hirahara ◽  
Takeshi Matsubara ◽  
Shunsuke Kaji ◽  
Yuki Uchida ◽  
Tetsu Yamamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Nasogastric Tube ◽  
Simple Technique ◽  
Gastric Conduit ◽  
Intraluminal Pressure ◽  
Linear Stapler ◽  
Thoracic Esophageal Cancer ◽  
Nylon Thread ◽  
Lesser Curvature

Abstract Background Risk factors for anastomotic leakage include local factors such as excessive tension across anastomosis and increased intraluminal pressure on the gastric conduit; therefore, we consider the placement of a nasogastric tube to be essential in reducing anastomotic leakage. In this study, we devised a safe and simple technique to place an NGT during an end-to-side, automatic circular-stapled esophagogastrostomy. Methods First, a 4-0 nylon thread is fixed in the narrow groove between the plastic and metal parts of the tip of the anvil head. After dissecting the esophagus, the tip of the NGT is guided out of the lumen of the cervical esophageal stump. The connecting nylon thread is applied to the anvil head with the tip of the NGT. The anvil head is inserted into the cervical esophageal stump, and a purse-string suture is performed on the esophageal stump to complete the anvil head placement. The main unit of the automated stapler is inserted through the tip of a reconstructed gastric conduit, and the stapler is subsequently fired and an end-to-side esophagogastrostomy is achieved. The main unit of the automated stapler is then pulled out from the gastric conduit, and the NGT comes out with the anvil head from the tip of the reconstructed gastric conduit. Subsequently, the nylon thread is cut. After creating an α-loop with the NGT outside of the lumen, the tip of the NGT is inserted into the gastric conduit along the lesser curvature toward the caudal side. Finally, the inlet of the automated stapler on the tip of the gastric conduit is closed with an automated linear stapler, and the esophagogastrostomy is completed. Results We utilized this technique in seven patients who underwent esophagectomy for esophageal cancer; smooth and safe placement of the NGT was accomplished in all cases. Conclusion Our technique of NGT placement is simple, safe, and feasible.

PS02.076: VISUALIZATION OF BLOOD SUPPLY ROUTE TO THE RECONSTRUCTED STOMACH BY INDOCYANINE GREEN FLUORESCENCE IMAGING DURING ESOPHAGECTOMY, 2ND REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 141-142
Author(s):  
Yasushi Rino ◽  
Takashi Oshima ◽  
Tsutomu Sato ◽  
Toru Aoyama ◽  
Norio Yukawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Esophageal Cancer ◽  
Blood Vessels ◽  
Fluorescence Imaging ◽  
Blood Supply ◽  
Gastric Wall ◽  
Gastroepiploic Artery ◽  
Greater Omentum ◽  
Splenic Hilum ◽  
Greater Curvature

Abstract Background Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We have reported the three blood supply routes to the reconstructed stomach using ICG fluorescence imaging for reconstruction during esophagectomy. Blood flow routes in the 33 patients with esophageal cancer were classified into categories on the basis of ICG imaging findings: the gastric wall route, the greater curvature route, and the omentum and splenic hiatal route. The gastric wall route was found in 13 patients and characterized by large blood vessels in the gastric wall. The greater curvature route was present in 11 patients and characterized by blood vessels in the greater omentum. The omentum and beside splenic hilum route was found in 22 patients. Blood vessels ran in the greater omentum beside the splenic hilum. a photodynamic eye (PDE) showed blood flow from right gastroepiploic artery, omentum vessels, left gastroepiploic artery, splenic hiatal vessels, short gastric artery, and gastric wall vessels to the top of the reconstructed stomach. The ‘splenic hiatal route’ was present in 66.7% of the patients and was formed by large vessels or networks of small vessels. We rechecked the ‘splenic hiatal route’ cases and recognize that the branch parted from the right gastroepiploic artery. We tried preservation of the ‘splenic hiatal route’. Methods Since January 2017, we have preserved the ‘splenic hiatal route’ and performed ICG fluorescence imaging in 5 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded. Results ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was visualized the ‘splenic hiatal route’ in all patients. Conclusion On ICG fluorescence imaging, the splenic hiatal vessels would be the major blood supply for the anastomosis in most patients. Disclosure All authors have declared no conflicts of interest.

scholarly journals Blood flow speed of the gastric conduit assessed by indocyanine green fluorescence

Medicine ◽  
2016 ◽  
Vol 95 (30) ◽  
pp. e4386 ◽  
Author(s):  
Kazuo Koyanagi ◽  
Soji Ozawa ◽  
Junya Oguma ◽  
Akihito Kazuno ◽  
Yasushi Yamazaki ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Flow Speed ◽  
Gastric Conduit ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence
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