Perfusion assessment by fluorescence time curves in esophagectomy with gastric conduit reconstruction: a prospective clinical study
| العنوان: | Perfusion assessment by fluorescence time curves in esophagectomy with gastric conduit reconstruction: a prospective clinical study |
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| المؤلفون: | J. J. Joosten, M. D. Slooter, R. M. van den Elzen, P. R. Bloemen, S. S. Gisbertz, W. J. Eshuis, F. Daams, D. M. de Bruin, M. I. van Berge Henegouwen |
| المساهمون: | Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Imaging and biomarkers, Biomedical Engineering and Physics, CCA - Cancer biology and immunology, CCA -Cancer Center Amsterdam, Urology, ACS - Atherosclerosis & ischemic syndromes, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism |
| المصدر: | Surgical endoscopy. Springer New York Surgical Endoscopy. Springer New York Joosten, J J, Slooter, M D, van den Elzen, R M, Bloemen, P R, Gisbertz, S S, Eshuis, W J, Daams, F, de Bruin, D M & van Berge Henegouwen, M I 2023, ' Perfusion assessment by fluorescence time curves in esophagectomy with gastric conduit reconstruction : a prospective clinical study ', Surgical Endoscopy, vol. 37, no. 8, pp. 6343-6352 . https://doi.org/10.1007/s00464-023-10107-9 |
| سنة النشر: | 2023 |
| مصطلحات موضوعية: | Surgery |
| الوصف: | Background Intraoperative perfusion assessment with indocyanine green fluorescence angiography (ICG-FA) may reduce postoperative anastomotic leakage rates after esophagectomy with gastric conduit reconstruction. This study evaluated quantitative parameters derived from fluorescence time curves to determine a threshold for adequate perfusion and predict postoperative anastomotic complications. Methods This prospective cohort study included consecutive patients who underwent FA-guided esophagectomy with gastric conduit reconstruction between August 2020 and February 2022. After intravenous bolus injection of 0.05-mg/kg ICG, fluorescence intensity was registered over time by PINPOINT camera (Stryker, USA). Fluorescent angiograms were quantitatively analyzed at a region of interest of 1 cm diameter at the anastomotic site on the conduit using tailor-made software. Extracted fluorescence parameters were both inflow (T0, Tmax, Fmax, slope, Time-to-peak) as outflow parameters (T90% and T80%). Anastomotic complications including anastomotic leakage (AL) and strictures were documented. Fluorescence parameters in patients with AL were compared to those without AL. Results One hundred and three patients (81 male, 65.7 ± 9.9 years) were included, the majority of whom (88%) underwent an Ivor Lewis procedure. AL occurred in 19% of patients (n = 20/103). Both time to peak as Tmax were significantly longer for the AL group in comparison to the non-AL group (39 s vs. 26 s, p = 0.04 and 65 vs. 51 s, p = 0.03, respectively). Slope was 1.0 (IQR 0.3–2.5) and 1.7 (IQR 1.0–3.0) for the AL and non-AL group (p = 0.11). Outflow was longer in the AL group, although not significantly, T90% 30 versus 15 s, respectively, p = 0.20). Univariate analysis indicated that Tmax might be predictive for AL, although not reaching significance (p = 0.10, area under the curve 0.71) and a cut-off value of 97 s was derived, with a specificity of 92%. Conclusion This study demonstrated quantitative parameters and identified a fluorescent threshold which could be used for intraoperative decision-making and to identify high-risk patients for anastomotic leakage during esophagectomy with gastric conduit reconstruction. A significant predictive value remains to be determined in future studies. |
| اللغة: | English |
| تدمد: | 0930-2794 |
| DOI: | 10.1007/s00464-023-10107-9 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1d6a2624c8e626f1bff8cd102bfbe118 https://pure.amc.nl/en/publications/perfusion-assessment-by-fluorescence-time-curves-in-esophagectomy-with-gastric-conduit-reconstruction(e919359c-aa8f-49cb-9bcc-92c4ef6f3722).html |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....1d6a2624c8e626f1bff8cd102bfbe118 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 09302794 |
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| DOI: | 10.1007/s00464-023-10107-9 |