PDF(Pubmed)
Abstract：
Intraoperative perfusion assessment with indocyanine green fluorescence angiography (ICG-FA) may reduce postoperative anastomotic leakage rates after esophagectomy with gastric conduit reconstruction. This study evaluated quantitative parameters derived from fluorescence time curves to determine a threshold for adequate perfusion and predict postoperative anastomotic complications.
This prospective cohort study included consecutive patients who underwent FA-guided esophagectomy with gastric conduit reconstruction between August 2020 and February 2022. After intravenous bolus injection of 0.05-mg/kg ICG, fluorescence intensity was registered over time by PINPOINT camera (Stryker, USA). Fluorescent angiograms were quantitatively analyzed at a region of interest of 1 cm diameter at the anastomotic site on the conduit using tailor-made software. Extracted fluorescence parameters were both inflow (T0, Tmax, Fmax, slope, Time-to-peak) as outflow parameters (T90% and T80%). Anastomotic complications including anastomotic leakage (AL) and strictures were documented. Fluorescence parameters in patients with AL were compared to those without AL.
One hundred and three patients (81 male, 65.7 ± 9.9 years) were included, the majority of whom (88%) underwent an Ivor Lewis procedure. AL occurred in 19% of patients (n = 20/103). Both time to peak as Tmax were significantly longer for the AL group in comparison to the non-AL group (39 s vs. 26 s, p = 0.04 and 65 vs. 51 s, p = 0.03, respectively). Slope was 1.0 (IQR 0.3-2.5) and 1.7 (IQR 1.0-3.0) for the AL and non-AL group (p = 0.11). Outflow was longer in the AL group, although not significantly, T90% 30 versus 15 s, respectively, p = 0.20). Univariate analysis indicated that Tmax might be predictive for AL, although not reaching significance (p = 0.10, area under the curve 0.71) and a cut-off value of 97 s was derived, with a specificity of 92%.
This study demonstrated quantitative parameters and identified a fluorescent threshold which could be used for intraoperative decision-making and to identify high-risk patients for anastomotic leakage during esophagectomy with gastric conduit reconstruction. A significant predictive value remains to be determined in future studies.
This prospective cohort study included consecutive patients who underwent FA-guided esophagectomy with gastric conduit reconstruction between August 2020 and February 2022. After intravenous bolus injection of 0.05-mg/kg ICG, fluorescence intensity was registered over time by PINPOINT camera (Stryker, USA). Fluorescent angiograms were quantitatively analyzed at a region of interest of 1 cm diameter at the anastomotic site on the conduit using tailor-made software. Extracted fluorescence parameters were both inflow (T0, Tmax, Fmax, slope, Time-to-peak) as outflow parameters (T90% and T80%). Anastomotic complications including anastomotic leakage (AL) and strictures were documented. Fluorescence parameters in patients with AL were compared to those without AL.
One hundred and three patients (81 male, 65.7 ± 9.9 years) were included, the majority of whom (88%) underwent an Ivor Lewis procedure. AL occurred in 19% of patients (n = 20/103). Both time to peak as Tmax were significantly longer for the AL group in comparison to the non-AL group (39 s vs. 26 s, p = 0.04 and 65 vs. 51 s, p = 0.03, respectively). Slope was 1.0 (IQR 0.3-2.5) and 1.7 (IQR 1.0-3.0) for the AL and non-AL group (p = 0.11). Outflow was longer in the AL group, although not significantly, T90% 30 versus 15 s, respectively, p = 0.20). Univariate analysis indicated that Tmax might be predictive for AL, although not reaching significance (p = 0.10, area under the curve 0.71) and a cut-off value of 97 s was derived, with a specificity of 92%.
This study demonstrated quantitative parameters and identified a fluorescent threshold which could be used for intraoperative decision-making and to identify high-risk patients for anastomotic leakage during esophagectomy with gastric conduit reconstruction. A significant predictive value remains to be determined in future studies.
摘要：
背景：用吲哚菁绿荧光血管造影术（ICG-FA）进行术中灌注评估可降低食管切除胃导管重建术后吻合口漏的发生率。这项研究评估了从荧光时间曲线得出的定量参数，以确定足够灌注的阈值并预测术后吻合并发症。
方法：这项前瞻性队列研究纳入了2020年8月至2022年2月期间接受FA引导下食管切除术和胃导管重建的连续患者。静脉推注0.05-mg/kgICG后，荧光强度随时间通过PINPOINT相机(Stryker，美国）。使用定制的软件在导管上吻合部位处的Icm直径的感兴趣区域对荧光血管造影图进行定量分析。提取的荧光参数均为流入（T0，Tmax，Fmax,斜坡,达到峰值的时间）作为流出参数（T90%和T80%）。记录了吻合口并发症，包括吻合口漏（AL）和狭窄。将患有AL的患者的荧光参数与没有AL的患者进行比较。
结果：一百零三名患者（81名男性，包括65.7±9.9年），其中大多数(88%)接受了IvorLewis手术。19％的患者发生AL（n=20/103）。与非AL组相比，AL组的Tmax达到峰值的时间均明显更长（39svs.26s,p=0.04和65vs.51s,分别为p=0.03)。AL和非AL组的斜率分别为1.0（IQR0.3-2.5）和1.7（IQR1.0-3.0）（p=0.11）。AL组的流出时间更长，虽然不重要，T90%30对15s，分别,p=0.20)。单因素分析表明Tmax可能是AL的预测指标，虽然没有达到显著性(p=0.10，曲线下面积0.71)，但得出的临界值为97s，特异性为92%。
结论：这项研究证明了定量参数，并确定了荧光阈值，该阈值可用于术中决策，并可用于确定食管切除术和胃导管重建期间吻合口漏的高危患者。在未来的研究中仍有重要的预测价值有待确定。
方法：这项前瞻性队列研究纳入了2020年8月至2022年2月期间接受FA引导下食管切除术和胃导管重建的连续患者。静脉推注0.05-mg/kgICG后，荧光强度随时间通过PINPOINT相机(Stryker，美国）。使用定制的软件在导管上吻合部位处的Icm直径的感兴趣区域对荧光血管造影图进行定量分析。提取的荧光参数均为流入（T0，Tmax，Fmax,斜坡,达到峰值的时间）作为流出参数（T90%和T80%）。记录了吻合口并发症，包括吻合口漏（AL）和狭窄。将患有AL的患者的荧光参数与没有AL的患者进行比较。
结果：一百零三名患者（81名男性，包括65.7±9.9年），其中大多数(88%)接受了IvorLewis手术。19％的患者发生AL（n=20/103）。与非AL组相比，AL组的Tmax达到峰值的时间均明显更长（39svs.26s,p=0.04和65vs.51s,分别为p=0.03)。AL和非AL组的斜率分别为1.0（IQR0.3-2.5）和1.7（IQR1.0-3.0）（p=0.11）。AL组的流出时间更长，虽然不重要，T90%30对15s，分别,p=0.20)。单因素分析表明Tmax可能是AL的预测指标，虽然没有达到显著性(p=0.10，曲线下面积0.71)，但得出的临界值为97s，特异性为92%。
结论：这项研究证明了定量参数，并确定了荧光阈值，该阈值可用于术中决策，并可用于确定食管切除术和胃导管重建期间吻合口漏的高危患者。在未来的研究中仍有重要的预测价值有待确定。
