OBJECTIVE

To determine the prospects and feasibility of intraoperative using indocyanine green fluorescence angiography (ICG-FA) to assess tissue perfusion in minimally invasive surgery for esophageal and EGJ cancer.

MATERIAL AND METHODS

29 patients with esophageal cancer or EGJ cancer Sievert Type I, who were treated in the N.N. Burdenko faculty surgery clinic №1 (Sechenov University) from 2014 to 2022. All patients underwent minimally invasive subtotal esophagectomy: McKeon’s procedure — 26 patients, Ivor Lewis — 2 and left side esophago-coloplasty — 1 patient. Patients were divided into two groups: with or without ICG-FA. First group patients underwent ICG tumour marking and/or intraoperative angiography during reconstructive surgery. Patients in the comparison group were without ICG-FA and/or tumor marking. There were no difference in age, gender and physical health status in two groups.

RESULTS

Inadequate blood supply of the esophageal graft was revealed in 3 (20%) observations (2 — oesophageal reconstruction with a gastric conduit; 1 — oesophageal reconstruction by colon interposition) after ICG-FA, which allowed timely and thorough resection of its proximal edge and subsequently formation of an anastomosis. In another observation, during McKeon’s thoraco-laparoscopic surgery, it was possible to visualize the poor blood supply zone of the formed esophago-gastroanastomosis through ICG-FA, which indicated a high risk of anastomotic leakage. As a result, surgical tactics were changed in favor of esophagocoloplasty.

CONCLUSION

In our study, we did not get a significant difference in the frequency of postoperative complications in the two groups. However, intraoperative use of FA with intravenous ICG administration is a promising direction in esophageal surgery. The method makes it possible to assess the blood supply to the anastomosed organs, thereby assessing the possible risks of life-threatening complications.