Lijin Selvens, (2022) Evaluation of Gastric Conduit Perfusion during Esophagectomy using Indocyanine Green. Masters thesis, Christian Medical College, Vellore.
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Abstract
PURPOSE OF THE STUDY: To use indocyanine green fluorescence imaging to assess the perfusion of gastric conduit created during esophagectomy. BACKGROUND: In oesophageal cancer surgery, anastomotic leak is one of the important causes of morbidity and mortality. Ensuring an adequate conduit vascularity is the key factor for reducing anastomotic leaks. Recently, various innovative techniques have been used to aid surgeon’s judgment of gastric conduit vascularity; one among them is ICG fluorescence infra-red imaging. OBJECTIVES: To evaluate the use of indocyanine green fluorescence imaging as a method to assess the perfusion of gastric conduit and its correlation with anastomotic leaks. STUDY DESIGN: Prospective observational study. METHODS: In this study, newly diagnosed patients with carcinoma oesophagus were recruited before the operation and followed up until two weeks post operatively. Preoperatively, information on demography, clinical (disease characteristics, comorbid illnesses, details on neo-adjuvant therapy) and biochemical parameters (haemoglobin, serum albumin, absolute neutrophil count) were collected. The patients undergoing McKeown esophagectomy and Ivor Lewis esophagectomy were included in the study. In both the type of operations, the diseased oesophagus is approached through the thorax, abdomen, and neck, as required, and resection was carried out. The stomach is then fashioned into a tubular conduit to replace the resected oesophagus. This gastric conduit is then pulled up into the neck/thorax through the posterior mediastinum and the anastomosis is completed. After the gastric conduit is fashioned and before it is pulled up into the neck/thorax, the surgeon clinically assessed (visual assessment) the vascularity of the conduit based on its appearance and presence of pulsations and recorded the findings. Following this, 5mg of ICG was administered via a peripheral venous access and simultaneously real time imaging of the conduit would be done with a near infrared camera and the images and findings were recorded. Initial images were acquired at 15-40 seconds to identify the “rapid” and “low” perfusion areas and delayed images were acquired at 40-60 seconds to identify the “slow” perfusion areas (Fig. a & b). Following this, the conduit was pulled up to the neck/thorax and the vascularity was assessed again clinically and after giving a second dose of 5mg ICG as described. Post operatively, the subjects were followed up for any clinical features of cervical anastomotic leak up to two weeks. In case of a suspected cervical anastomotic leak, the patient was managed according to the existing protocols. RESULTS: This study showed that there was significant relation between real time change in ICG imaging findings after pulling the conduit into thorax/neck and post operative anastomotic leak with a Z score of -2.294 and p-value of 0.022. The post operative anastomotic leak percentage in the study was 12.50% (2/15 cases). CONCLUSION: There was significant relation of the real time change in ICG fluorescence imaging findings with post operative anastomotic leak making it a good predictor of anastomotic leaks. ICG fluorescent imaging was done in real time and can be used to effectively evaluate the perfusion of the gastric conduit in esophagectomy. However, as the sample size could not be completed in this study, further patient numbers may be required to conclusively affirm this finding.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221911456 |
| Uncontrolled Keywords: | Gastric Conduit Perfusion, Esophagectomy, Indocyanine Green. |
| Subjects: | MEDICAL > General Surgery > MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Jun 2021 10:37 |
| Last Modified: | 03 Mar 2024 13:52 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/17864 |
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