The first experience of fluorescent angiography with indocyanine green in primary esophagoplasty with gastric conduit in patients with malignant tumors of the esophagus

Dvoretsky S.Yu.; Kapshuk Ya.Yu.; Komarov I.V.; Akopov A.L.

doi:https://doi.org/10.17116/hirurgia202311172

S.Yu. Dvoretsky

Pavlov First State Medical University of St. Petersburg

ORCID: 0000-0001-8746-9343

Ya.Yu. Kapshuk

Pavlov First State Medical University of St. Petersburg

ORCID: 0000-0001-9500-1716

I.V. Komarov

Pavlov First State Medical University of St. Petersburg

ORCID: 0009-0000-7288-8991

A.L. Akopov

Pavlov St. Petersburg First State Medical University

ORCID: 0000-0001-8698-7018

The first experience of fluorescent angiography with indocyanine green in primary esophagoplasty with gastric conduit in patients with malignant tumors of the esophagus

Authors:

S.Yu. Dvoretsky, Ya.Yu. Kapshuk, I.V. Komarov, A.L. Akopov

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Journal: Pirogov Russian Journal of Surgery. 2023;(11): 72‑81

DOI: 10.17116/hirurgia202311172

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To cite this article:

Dvoretsky SYu, Kapshuk YaYu, Komarov IV, Akopov AL. The first experience of fluorescent angiography with indocyanine green in primary esophagoplasty with gastric conduit in patients with malignant tumors of the esophagus. Pirogov Russian Journal of Surgery. 2023;(11):72‑81. (In Russ.)
https://doi.org/10.17116/hirurgia202311172

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To evaluate the possibilities of intraoperative indocyanine green fluorescein angiography (ICG technology) in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus.

MATERIAL AND METHODS

The study included 74 patients. Depending on the localization of the tumor in the esophagus, a Lewis-type or McKeown-type operation was performed. The retrospective group (surgery without the use of ICG technology) included 53 patients who underwent surgery from 2015 to 2020 years.The prospective group (surgery with the use ICG technology) included 21 patients operated on from 2021 to 2023 years. ICG technology was used to assess microcirculation in the gastric conduit during esophagoplasty, as well as to identify the right gastroepiploic artery.

RESULTS

The ICG fluorescein angiography technique for assessing microcirculation in the gastric conduit was a simple and easily reproducible procedure. Perfusion of the gastric conduit was regarded as satisfactory in 16 (76%) cases, unsatisfactory in 5 (24%) cases, which required resection of the distal part of the conduit. All cases of poor perfusion were in patients with narrow gastric conduit and neck anastomosis location (McKeown-type operation). Anastomotic leakages occurred in 8 (15%) patients in the retrospective group, 4 (19%) patients in the prospective group (p>0.05). In 4 out of 5 cases of poor gastric conduit perfusion, anastomotic leaks occurred. Immediate postoperative results in the compared groups were also comparable. The use of ICG technology in 5 (45%) cases out of 11, when laparoscopic mobilization of the stomach was performed, helped to visualize the right gastroepiploic artery, which is the main source of blood supply to the formed gastric conduit. The use of ICG technology in 3 patients with a compromised gastrostomy stomach demonstrated the absence of significant microcirculation disorders in the stomach wall.

CONCLUSION

The first experience of using fluorescein angiography with ICG in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus demonstrated the safety, simplicity and availability of this technique. An objective assessment of the effectiveness of the application of ICG technology requires the accumulation of experience.

Keywords:

malignant tumors of the esophagus

indocyanine green fluorescein angiography

ICG technology

primary esophagoplasty

Authors:

S.Yu. Dvoretsky

Pavlov First State Medical University of St. Petersburg

ORCID: 0000-0001-8746-9343

Ya.Yu. Kapshuk

Pavlov First State Medical University of St. Petersburg

ORCID: 0000-0001-9500-1716

I.V. Komarov

Pavlov First State Medical University of St. Petersburg

ORCID: 0009-0000-7288-8991

A.L. Akopov

Pavlov St. Petersburg First State Medical University

ORCID: 0000-0001-8698-7018

Received:

03.04.2023

Accepted:

11.05.2023

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