• Humans
• Esophagectomy/methods
• Esophageal Neoplasms/surgery
• Retrospective Studies
• Treatment Outcome
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Anastomotic Leak/surgery
• Anastomosis, Surgical

• Anastomotic leak
• Esophagectomy
• Gastric pull-up
• Neck leak
• Vascular calcification

• Male
• Female
• Humans
• Middle Aged
• Anastomotic Leak/diagnostic imaging
• Anastomotic Leak/epidemiology
• Anastomotic Leak/etiology
• Esophagectomy/adverse effects
• Esophagectomy/methods
• Retrospective Studies
• Esophageal Neoplasms/complications
• Calcinosis/diagnostic imaging
• Calcinosis/etiology
• Calcinosis/surgery
• Anastomosis, Surgical/adverse effects

• Anastomosis
• Animal model
• Esophagectomy
• Ischemia
• Stricture

• Anastomotic leakage
• Esophagectomy
• Indocyanine green angiography
• Ivor lewis
• Near infrared fluorescence imaging
• Stomach graft

• Anastomotic leak
• Esophagus
• Microdialysis

Ischemia is considered as the main reason for thoracic gastroesophageal anastomotic leaks after esophagectomy. Microcirculatory monitoring with laser Doppler flowmetry and visible light spectroscopy may provide valuable intraoperative real-time information about the gastric tube’s tissue perfusion and circulation.

Ten patients with esophageal cancer operated with minimally invasive esophagectomy participated in this single-center, prospective, observational pilot study. A single probe with laser Doppler flowmetry and visible light spectroscopy was used to perform transserosal microcirculation assessment of the gastric tube at predefined anatomical sites during different operation phases. Group comparison and changes were evaluated using the paired sample t-test.

A reduction in StO2 was found at all measuring sites after the gastric tube formation compared with the baseline measurements. The mean StO2 reduction from baseline to gastric tube formation and after anastomosis was 16% (range 4%–28%) and 42% (range, 35%–52%), respectively. A statistically significant increase in the rHb concentration, representing venous congestion, was detected at the most cranial part of the gastric tube (P = 0.04). Three patients developed anastomotic leaks.

Intraoperative real-time laser Doppler flowmetry and visible light spectroscopy are feasible and may provide insight to microcirculatory changes in the gastric tube and at the anastomotic site. Patients with anastomotic leaks seem to have critical local tissue StO2 reduction and venous congestion that should be further evaluated in studies with larger sample sizes.

• esophagectomy
• gastric tube circulation
• gastroesophageal anastomosis complications

Anastomotic leaks (AL) and gastric conduit necrosis (CN) are serious complications following oesophagectomy. Some studies have suggested that vascular calcification may be associated with an increased AL rate, but this has not been validated in a United Kingdom population.

To investigate whether vascular calcification identified on the pre-operative computed tomography (CT) scan is predictive of AL or CN.

Routine pre-operative CT scans of 414 patients who underwent oesophagectomy for malignancy with oesophagogastric anastomosis at the Queen Elizabeth Hospital Birmingham between 2006 and 2018 were retrospectively analysed. Calcification of the proximal aorta, distal aorta, coeliac trunk and branches of the coeliac trunk was scored by two reviewers. The relationship between these calcification scores and occurrence of AL and CN was then analysed. The Esophagectomy Complications Consensus Group definition of AL and CN was used.

Complication data were available in n = 411 patients, of whom 16.7% developed either AL (15.8%) or CN (3.4%). Rates of AL were significantly higher in female patients, at 23.0%, compared to 13.9% in males (P = 0.047). CN was significantly more common in females, (8.0% vs 2.2%, P = 0.014), patients with diabetes (10.6% vs 2.5%, P = 0.014), a history of smoking (10.3% vs 2.3%, P = 0.008), and a higher American Society of Anaesthesiologists grade (P = 0.024). Out of the 14 conduit necroses, only 4 occurred without a concomitant AL. No statistically significant association was found between calcification of any of the vessels studied and either of these outcomes. Multivariable analyses were then performed to identify whether a combination of the calcification scores could be identified that would be significantly predictive of any of the outcomes. However, the stepwise approach did not select any factors for inclusion in the final models. The analysis was repeated for composite outcomes of those patients with either AL or CN (n = 69, 16.7%) and for those with both AL and CN (n = 10, 2.4%) and again, no significant associations were detected. In the subset of patients that developed these outcomes, no significant associations were detected between calcification and the severity of the complication.

Calcification scoring was not significantly associated with Anastomotic Leak or CN in our study, therefore should not be used to identify patients who are high risk for these complications.

• Oesophagectomy
• Anastomotic leak
• Gastric conduit necrosis
• Calcification
• Computed tomography
• Ischaemia

After an esophagectomy, the stomach is most commonly used to restore continuity of the upper gastrointestinal tract. These esophago-gastric anastomoses are prone to serious complications such as leakage associated with high morbidity and mortality. Graft perfusion is considered to be an important predictor for anastomotic integrity. Based on the current literature we believe Indocyanine green fluorescence angiography (ICGA) is an easy assessment tool for gastric tube (GT) perfusion, and it might predict anastomotic leakage (AL).

To evaluate feasibility and effectiveness of ICGA in GT perfusion assessment and as a predictor of AL.

This study was designed according to the PRISMA guidelines and registered in the PROSPERO database. PubMed and EMBASE were independently searched by 2 reviewers for studies presenting data on intraoperative ICGA GT perfusion assessment during esophago-gastric reconstruction after esophagectomy. Relevant outcomes such as feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications, were collected by 2 independent researchers. The quality of the included articles was assessed based on the Methodological Index for Non-Randomized Studies. The 19 included studies presented data on 1192 esophagectomy patients, in 758 patients ICGA was used perioperative to guide esophageal reconstruction.

The 19 included studies for qualitative analyses all described ICGA as a safe and easy method to evaluate gastric graft perfusion. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group (P < 0.001). When poorly perfused cases are excluded from the analyses, the difference in AL was even larger (AL well-perfused group 6.3% vs control group 20.5%, P < 0.001). The AL rate in the group with an altered surgical plan based on the ICG image was 6.5%, similar to the well perfused group (6.3%) and significantly less than the poorly perfused group (47.8%) (P < 0.001), suggesting that the technique is able to identify and alter a potential bad outcome.

ICGA is a safe, feasible and promising method for perfusion assessment. The lower AL rate in the well perfused group suggest that a good fluorescent signal predicts a good outcome.

• Indocyanine green
• Angiography
• Fluorescence
• Esophagectomy
• Anastomotic leak
• Near-infrared spectroscopy
• Esophageal neoplasms
• Esophageal cancer

• Esophageal Neoplasms/diagnostic imaging
• Esophageal Neoplasms/surgery
• Humans
• Indocyanine Green/therapeutic use
• Lung/diagnostic imaging
• Lung/surgery
• Lung Neoplasms/diagnostic imaging
• Lung Neoplasms/surgery
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Monitoring, Intraoperative/methods
• Optical Imaging/methods
• Sentinel Lymph Node Biopsy/methods
• Spectroscopy, Near-Infrared/methods
• Thoracic Surgical Procedures/methods