Circular stapling anastomosis with indocyanine green fluorescence imaging for cervical esophagogastric anastomosis after thoracoscopic esophagectomy: a propensity score-matched analysis

• Published in: BMC surgery Vol. 22; no. 1; p. 152
• Main Authors: Shishido, Yuji, Matsunaga, Tomoyuki, Makinoya, Masahiro, Miyauchi, Wataru, Shimizu, Shota, Miyatani, Kozo, Uejima, Chihiro, Morimoto, Masaki, Murakami, Yuki, Hanaki, Takehiko, Kihara, Kyoichi, Yamamoto, Manabu, Tokuyasu, Naruo, Takano, Shuichi, Sakamoto, Teruhisa, Saito, Hiroaki, Hasegawa, Toshimichi, Fujiwara, Yoshiyuki
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.04.2022; BioMed Central; BMC
• Subjects: Abdomen; Anastomosis; Anastomosis, Surgical - methods; Anastomotic leak; Anastomotic Leak - etiology; Anastomotic leakage; Cancer; Cervical esophagogastric anastomosis; Circular stapling anastomosis; Complications; Constriction, Pathologic - surgery; Dissection; Esophageal cancer; Esophageal Neoplasms - pathology; Esophagectomy - adverse effects; Fluorescence; Humans; Indocyanine Green; Indocyanine green fluorescence imaging; Laparoscopy; Laparotomy; Lymph nodes; Lymphatic system; Matching; Medical colleges; Medical imaging; Medical research; Medicine, Experimental; Methods; Multivariate analysis; Optical Imaging; Patients; Propensity Score; Regression analysis; Risk analysis; Risk factors; Robots; Stenosis; Surgery; Thoracoscopic esophagectomy; United States > US; Minnesota; California; Circular stapling anastomosis; Anastomotic leakage; Anastomotic stenosis; Indocyanine green fluorescence imaging; Propensity score matching; Thoracoscopic esophagectomy; Cervical esophagogastric anastomosis; Esophageal cancer
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-022-01602-2

Thoracoscopic esophagectomy has been extensively used worldwide as a curative surgery for patients with esophageal cancer; however, complications such as anastomotic leakage and stenosis remain a major concern. Therefore, the objective of this study was to evaluate the efficacy of circular stapling anastomosis with indocyanine green (ICG) fluorescence imaging, which was standardized for cervical esophagogastric anastomosis after thoracoscopic esophagectomy. Altogether, 121 patients with esophageal cancer who underwent thoracoscopic esophagectomy with radical lymph node dissection and cervical esophagogastric anastomosis from November 2009 to December 2020 at Tottori University Hospital were enrolled in this study. Patients who underwent surgery before the anastomotic method was standardized were included in the classical group (n = 82) and patients who underwent surgery after the anastomotic method was standardized were included in the ICG circular group (n = 39). The short-term postoperative outcomes, including anastomotic complications, were compared between the two groups using propensity-matched analysis and the risk factors for anastomotic leakage were evaluated using logistic regression analyses. Of the 121 patients, 33 were included in each group after propensity score matching. The clinicopathological characteristics of patients did not differ between the two groups after propensity score matching. In terms of perioperative outcomes, a significantly higher proportion of patients who underwent surgery using the laparoscopic approach (P < 0.001) and narrow gastric tube (P = 0.003), as well as those who had a lower volume of blood loss (P = 0.009) in the ICG circular group were observed after matching. Moreover, the ICG circular group had a significantly lower incidence of anastomotic leakage (39% vs. 9%, P = 0.004) and anastomotic stenosis (46% vs. 21%, P = 0.037) and a shorter postoperative hospital stay (30 vs. 20 days, P < 0.001) than the classical group. According to the multivariate analysis, the anastomotic method was an independent risk factor for anastomotic leakage after thoracoscopic esophagectomy (P = 0.013). Circular stapling anastomosis with ICG fluorescence imaging is effective in reducing complications such as anastomotic leakage and stenosis.