Indocyanine green in delayed esophageal reconstruction after previous extirpation

• Published in: Hirurgija (Moskva) no. 2. Vyp. 2; p. 67
• Main Authors: Smolenov, E I, Kolobaev, I V, Mironova, D Yu, Afonin, G V, Ryabov, A B
• Format: Journal Article
• Language: English; Russian
• Published: Russia (Federation) 2024
• Subjects: Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Anastomotic Leak - diagnosis; Anastomotic Leak - etiology; Anastomotic Leak - prevention & control; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - etiology; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Esophagectomy - methods; Humans; Indocyanine Green; Ischemia - etiology; Necrosis - surgery; Stomach - surgery; esophagectomy; colon interposition; esophageal cancer; fluorescence imaging; indocyanine green
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia202402267

Advanced chemo- and radiotherapy makes it possible to expand the cohort of patients who can undergo surgical treatment for esophageal cancer. Optimization of perioperative approach, diagnosis and modern options for complications reduced early postoperative mortality after esophagectomy. Conduit ischemia with failure of esophageal-gastric or esophageal-intestinal anastomosis is one of the most serious complications. To minimize the risk of anastomotic leakage and graft necrosis in these patients, various methods of intraoperative assessment of graft viability are being investigated. Near-infrared fluorescence imaging with indocyanine green is valuable for real time assessment of graft perfusion. To date, fluorescence imaging is analyzed regarding perfusion of the gastric stalk after esophagectomy. However, there are still few or no data on this method for analysis of colonic conduit perfusion. The absence of plastic material for gastrointestinal reconstruction is the most dangerous moment in case of ischemia and necrosis of colonic graft. We present our first case of delayed retrosternal esophageal repair using intraoperative indocyanine green fluorescence imaging for assessment of conduit perfusion.