ArticleLangenbeck's archives of surgery2025
Impact of indocyanine green fluorescence angiography on esophagogastric anastomotic leakage after Ivor Lewis esophagectomy.
Article in Langenbeck's archives of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEsophagectomy for esophageal cancer involves high morbimortality when anastomotic leakage occurs. Optimal perfusion of the gastric tube can be assessed by indocyanine green fluorescence-angiography (ICG-FA). We evaluated whether locating the anastomosis in a zone enhanced within 60 s after ICG-FA injection reduced severe anastomotic leakage (Stage 2 or 3) within 30 days after esophagectomy.
methodsICG-FA was assessed in 69 patients and compared to 122 control patients undergoing minimally invasive Ivor Lewis esophagectomy. Whenever possible, the anastomosis was placed on gastric tissue enhanced within 60 s after ICG-FA injection, with resection of the gastric tip if needed.
resultsSevere anastomotic leakage occurred in 8.4% of cases, with 6 cases of anastomotic leakage (8.7%) in the ICG-FA group and 10 (8.2%) in the non-ICG-FA group (p = 1.000). There was no difference in postoperative outcomes between both groups, the main complications being pulmonary. ICG-FA enhancement level at 60 s was below the gastric tip in 33.8% of cases, with lowering of the anastomotic site in 18% of cases and resection of the gastric tip in 23% of cases. Overall, use of ICG-FA changed the surgical management in 29.9% of patients, with 2 patients presenting with anastomotic leakage.
conclusionOur results were not statistically significant, possibly due to a lack of power. There was no trend indicating a decrease in anastomotic leakage using our ICG-FA method, therefore other studies must help determine an optimal quantitative ICG-FA method to reduce postoperative morbidity after esophagectomy.
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