ArticleSurgical endoscopy2022
Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy.
Article in Surgical endoscopy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Stapled vs. hand-sewn anastomosis during esophagectomy: a randomized trials systematic review and meta-analysis.Updates in surgery · 2026Pooled it
- The use of indocyanine green and near-infrared fluorescence in the detection of metastatic lymph nodes during oesophageal and gastric cancer resection: a systematic review and meta-analysis.Surgical endoscopy · 2025Pooled it
- Association of perioperative patient characteristics, intraoperative fluid management, and vasopressors with anastomotic leakage after Ivor-Lewis esophagectomy-a single center retrospective cohort.Surgical endoscopy · 2026Article
- The Role of Quantitative Indocyanine Green Angiography with Relative Perfusion Ratio in the Assessment of Gastric Conduit Perfusion in Oesophagectomy: A Retrospective Study.Journal of clinical medicine · 2025Article
- Advances in Minimally Invasive Esophagectomy-An Overview of Recent Developments and a Novel Classification of Innovations in Treatment of Thoracic Esophageal Cancer.Medicina (Kaunas, Lithuania) · 2025Review
- Modification of the lesser curvature incision line enhanced gastric conduit perfusion as determined by indocyanine green fluorescence imaging and decreased the incidence of anastomotic leakage following esophagectomy.Esophagus : official journal of the Japan Esophageal Society · 2025Article
- Current status and future trends of real-time imaging in gastric cancer surgery: A literature review.Heliyon · 2024Review
- Intraoperative assessment of anastomotic blood supply using indocyanine green fluorescence imaging following esophagojejunostomy or esophagogastrostomy for gastric cancer.Frontiers in oncology · 2024Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnastomotic leak is a serious complication following esophagectomy. The aim of the study was to report our experience with indocyanine green fluorescence angiography (ICG-FA)-PINPOINT® assisted minimally invasive Ivor Lewis esophagectomy (MILE) and assess factors associated with anastomotic leak.
methodsWe reviewed consecutive patients undergoing MILE from 2013 to 2018. Intraoperative real-time assessment of gastric conduit was performed using ICG-FA with PINPOINT®. Perfusion was categorized as good perfusion (brisk ICG visualization to conduit tip) or non-perfusion (any demarcation along the conduit).
results100 patients (81 males, median age 68 [60-72]) underwent MILE for malignancy in 96 patients and benign disease in 4 patients. There were six anastomotic leaks all managed with endoscopic stent placement. There was no intraoperative mortality and no 30-day mortality in leak patients. Patients with a leak were more likely to be overweight with BMI > 25 (100% versus 53%, p = 0.03), have pre-existing diabetes (50% versus 13%, p = 0.04), and have higher intraoperative estimated blood loss (260 mL [95-463] versus 75 mL [48-150], p = 0.03). Anastomotic leaks occurred more frequently in the non-perfusion (67%) versus the good perfusion category (33%, p = 0.03). By multivariable analysis, diabetes (odds ratio [OR] 6.42; p = 0.04) and non-perfusion (OR 6.60; p = 0.04) were independently associated with leak.
conclusionIntraoperative use of ICG-FA may be a useful adjunct to assess perfusion of the gastric conduit with non-perfusion being independently associated with a leak. While perfusion plays an important role in anastomotic integrity, development of a leak is multifactorial, and ICG-FA should be used in conjunction with the optimization of patient and procedural components to minimize leak rates. Prospective, randomized studies are required to validate the interpretation, efficacy, and application of this novel technology in minimally invasive esophagectomies.
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