Near-infrared fluorescence guided esophageal reconstructive surgery: A systematic review
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摘要
BACKGROUND After an esophagectomy, the stomach is most commonly used to restore continuity of the upper gastrointestinal tract. These esophago-gastric anastomoses are prone to serious complications such as leakage associated with high morbidity and mortality. Graft perfusion is considered to be an important predictor for anastomotic integrity. Based on the current literature we believe Indocyanine green fluorescence angiography(ICGA) is an easy assessment tool for gastric tube(GT) perfusion, and it might predict anastomotic leakage(AL).AIM To evaluate feasibility and effectiveness of ICGA in GT perfusion assessment and as a predictor of AL.METHODS This study was designed according to the PRISMA guidelines and registered in the PROSPERO database. PubMed and EMBASE were independently searched by 2 reviewers for studies presenting data on intraoperative ICGA GT perfusion assessment during esophago-gastric reconstruction after esophagectomy.Relevant outcomes such as feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications, were collected by 2 independent researchers. The quality of the included articles was assessed based on the Methodological Index for Non-Randomized Studies. The 19 included studies presented data on 1192 esophagectomy patients, in 758 patients ICGA was used perioperative to guide esophageal reconstruction.RESULTS The 19 included studies for qualitative analyses all described ICGA as a safe and easy method to evaluate gastric graft perfusion. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group(P <0.001). When poorly perfused cases are excluded from the analyses, the difference in AL was even larger(AL well-perfused group 6.3% vs control group 20.5%, P <0.001). The AL rate in the group with an altered surgical plan based on the ICG image was 6.5%, similar to the well perfused group(6.3%) and significantly less than the poorly perfused group(47.8%)(P < 0.001), suggesting that the technique is able to identify and alter a potential bad outcome.CONCLUSION ICGA is a safe, feasible and promising method for perfusion assessment. The lower AL rate in the well perfused group suggest that a good fluorescent signal predicts a good outcome.
BACKGROUND After an esophagectomy, the stomach is most commonly used to restore continuity of the upper gastrointestinal tract. These esophago-gastric anastomoses are prone to serious complications such as leakage associated with high morbidity and mortality. Graft perfusion is considered to be an important predictor for anastomotic integrity. Based on the current literature we believe Indocyanine green fluorescence angiography(ICGA) is an easy assessment tool for gastric tube(GT) perfusion, and it might predict anastomotic leakage(AL).AIM To evaluate feasibility and effectiveness of ICGA in GT perfusion assessment and as a predictor of AL.METHODS This study was designed according to the PRISMA guidelines and registered in the PROSPERO database. PubMed and EMBASE were independently searched by 2 reviewers for studies presenting data on intraoperative ICGA GT perfusion assessment during esophago-gastric reconstruction after esophagectomy.Relevant outcomes such as feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications, were collected by 2 independent researchers. The quality of the included articles was assessed based on the Methodological Index for Non-Randomized Studies. The 19 included studies presented data on 1192 esophagectomy patients, in 758 patients ICGA was used perioperative to guide esophageal reconstruction.RESULTS The 19 included studies for qualitative analyses all described ICGA as a safe and easy method to evaluate gastric graft perfusion. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group(P <0.001). When poorly perfused cases are excluded from the analyses, the difference in AL was even larger(AL well-perfused group 6.3% vs control group 20.5%, P <0.001). The AL rate in the group with an altered surgical plan based on the ICG image was 6.5%, similar to the well perfused group(6.3%) and significantly less than the poorly perfused group(47.8%)(P < 0.001), suggesting that the technique is able to identify and alter a potential bad outcome.CONCLUSION ICGA is a safe, feasible and promising method for perfusion assessment. The lower AL rate in the well perfused group suggest that a good fluorescent signal predicts a good outcome.
BACKGROUND After an esophagectomy, the stomach is most commonly used to restore continuity of the upper gastrointestinal tract. These esophago-gastric anastomoses are prone to serious complications such as leakage associated with high morbidity and mortality. Graft perfusion is considered to be an important predictor for anastomotic integrity. Based on the current literature we believe Indocyanine green fluorescence angiography(ICGA) is an easy assessment tool for gastric tube(GT) perfusion, and it might predict anastomotic leakage(AL).AIM To evaluate feasibility and effectiveness of ICGA in GT perfusion assessment and as a predictor of AL.METHODS This study was designed according to the PRISMA guidelines and registered in the PROSPERO database. PubMed and EMBASE were independently searched by 2 reviewers for studies presenting data on intraoperative ICGA GT perfusion assessment during esophago-gastric reconstruction after esophagectomy.Relevant outcomes such as feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications, were collected by 2 independent researchers. The quality of the included articles was assessed based on the Methodological Index for Non-Randomized Studies. The 19 included studies presented data on 1192 esophagectomy patients, in 758 patients ICGA was used perioperative to guide esophageal reconstruction.RESULTS The 19 included studies for qualitative analyses all described ICGA as a safe and easy method to evaluate gastric graft perfusion. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group(P <0.001). When poorly perfused cases are excluded from the analyses, the difference in AL was even larger(AL well-perfused group 6.3% vs control group 20.5%, P <0.001). The AL rate in the group with an altered surgical plan based on the ICG image was 6.5%, similar to the well perfused group(6.3%) and significantly less than the poorly perfused group(47.8%)(P < 0.001), suggesting that the technique is able to identify and alter a potential bad outcome.CONCLUSION ICGA is a safe, feasible and promising method for perfusion assessment. The lower AL rate in the well perfused group suggest that a good fluorescent signal predicts a good outcome.
引文
1 International Agency for Research on Cancer,WHO.Cancer Statistics,GLOBOCAN 2012:Estimated Cancer Incidence,Mortality and Prevalence Worldwide in 2012.Available from:URL:http://gco.iarc.fr/today/data/factsheets/cancers/6-Oesophagus-fact-sheet.pdf
2 Kassis ES,Kosinski AS,Ross P,Koppes KE,Donahue JM,Daniel VC.Predictors of anastomotic leak after esophagectomy:an analysis of the society of thoracic surgeons general thoracic database.Ann Thorac Surg 2013;96:1919-1926[PMID:24075499 DOI:10.1016/j.athoracsur.2013.07.119]
3 Biere SS,Maas KW,Cuesta MA,van der Peet DL.Cervical or thoracic anastomosis after esophagectomy for cancer:a systematic review and meta-analysis.Dig Surg 2011;28:29-35[PMID:21293129 DOI:10.1159/000322014]
4 Sauvanet A,Mariette C,Thomas P,Lozac'h P,Segol P,Tiret E,Delpero JR,Collet D,Leborgne J,Pradère B,Bourgeon A,Triboulet JP.Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction:predictive factors.J Am Coll Surg 2005;201:253-262[PMID:16038824 DOI:10.1016/j.jamcollsurg.2005.02.002]
5 Sunpaweravong S,Ruangsin S,Laohawiriyakamol S,Mahattanobon S,Geater A.Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients.Asian J Surg2012;35:104-109[PMID:22884266 DOI:10.1016/j.asjsur.2012.04.029]
6 Haga Y,Wada Y,Takeuchi H,Ikejiri K,Ikenaga M.Prediction of anastomotic leak and its prognosis in digestive surgery.World J Surg 2011;35:716-722[PMID:21184072 DOI:10.1007/s00268-010-0922-5]
7 Ruteg?rd M,Lagergren P,Rouvelas I,Lagergren J.Intrathoracic anastomotic leakage and mortality after esophageal cancer resection:a population-based study.Ann Surg Oncol 2012;19:99-103[PMID:21769467 DOI:10.1245/s10434-011-1926-6]
8 Van Daele E,Van de Putte D,Ceelen W,Van Nieuwenhove Y,Pattyn P.Risk factors and consequences of anastomotic leakage after Ivor Lewis oesophagectomy?.Interact Cardiovasc Thorac Surg 2016;22:32-37[PMID:26433973 DOI:10.1093/icvts/ivv276]
9 Wright CD,Kucharczuk JC,O'Brien SM,Grab JD,Allen MS;Society of Thoracic Surgeons General Thoracic Surgery Database.Predictors of major morbidity and mortality after esophagectomy for esophageal cancer:a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model.J Thorac Cardiovasc Surg 2009;137:587-595;discussion 596[PMID:19258071 DOI:10.1016/j.jtcvs.2008.11.042]
10 Junemann-Ramirez M,Awan MY,Khan ZM,Rahamim JS.Anastomotic leakage postesophagogastrectomy for esophageal carcinoma:retrospective analysis of predictive factors,management and influence on longterm survival in a high volume centre.Eur J Cardiothorac Surg 2005;27:3-7[PMID:15621463 DOI:10.1016/j.ejcts.2004.09.018]
11 Markar SR,Arya S,Karthikesalingam A,Hanna GB.Technical factors that affect anastomotic integrity following esophagectomy:systematic review and meta-analysis.Ann Surg Oncol 2013;20:4274-4281[PMID:23943033 DOI:10.1245/s10434-013-3189-x]
12 Milstein DM,Ince C,Gisbertz SS,Boateng KB,Geerts BF,Hollmann MW,van Berge Henegouwen MI,Veelo DP.Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy.Medicine(Baltimore)2016;95:e3875[PMID:27336874 DOI:10.1097/MD.0000000000003875]
13 Linder G,Hedberg J,Bj?rck M,Sundbom M.Perfusion of the gastric conduit during esophagectomy.Dis Esophagus 2017;30:143-149[PMID:27766735 DOI:10.1111/dote.12537]
14 Pham TH,Perry KA,Enestvedt CK,Gareau D,Dolan JP,Sheppard BC,Jacques SL,Hunter JG.Decreased conduit perfusion measured by spectroscopy is associated with anastomotic complications.Ann Thorac Surg 2011;91:380-385[PMID:21256274 DOI:10.1016/j.athoracsur.2010.10.006]
15 Tsekov C,Belyaev O,Tcholakov O,Tcherveniakov A.Intraoperative Doppler assessment of gastric tube perfusion in esophagogastroplasty.J Surg Res 2006;132:98-103[PMID:16154594 DOI:10.1016/j.jss.2005.07.037]
16 Alander JT,Kaartinen I,Laakso A,P?til?T,Spillmann T,Tuchin VV,Venermo M,V?lisuo P.A review of indocyanine green fluorescent imaging in surgery.Int J Biomed Imaging 2012;2012:940585[PMID:22577366 DOI:10.1155/2012/940585]
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18 Kubota K,Yoshida M,Kuroda J,Okada A,Ohta K,Kitajima M.Application of the HyperEye Medical System for esophageal cancer surgery:a preliminary report.Surg Today 2013;43:215-220[PMID:22782594 DOI:10.1007/s00595-012-0251-4]
19 Murawa D,Hünerbein M,Spycha?a A,Nowaczyk P,Po?om K,Murawa P.Indocyanine green angiography for evaluation of gastric conduit perfusion during esophagectomy--first experience.Acta Chir Belg 2012;112:275-280[PMID:23008991 DOI:10.1080/00015458.2012.11680838]
20 Pacheco PE,Hill SM,Henriques SM,Paulsen JK,Anderson RC.The novel use of intraoperative laserinduced fluorescence of indocyanine green tissue angiography for evaluation of the gastric conduit in esophageal reconstructive surgery.Am J Surg 2013;205:349-352;discussion 352-3[PMID:23414958DOI:10.1016/j.amjsurg.2012.11.005]
21 Kumagai Y,Ishiguro T,Haga N,Kuwabara K,Kawano T,Ishida H.Hemodynamics of the reconstructed gastric tube during esophagectomy:assessment of outcomes with indocyanine green fluorescence.World JSurg 2014;38:138-143[PMID:24196170 DOI:10.1007/s00268-013-2237-9]
22 Rino Y,Yukawa N,Sato T,Yamamoto N,Tamagawa H,Hasegawa S,Oshima T,Yoshikawa T,Masuda M,Imada T.Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy.BMC Med Imaging 2014;14:18[PMID:24885891 DOI:10.1186/1471-2342-14-18]
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2 Kassis ES,Kosinski AS,Ross P,Koppes KE,Donahue JM,Daniel VC.Predictors of anastomotic leak after esophagectomy:an analysis of the society of thoracic surgeons general thoracic database.Ann Thorac Surg 2013;96:1919-1926[PMID:24075499 DOI:10.1016/j.athoracsur.2013.07.119]
3 Biere SS,Maas KW,Cuesta MA,van der Peet DL.Cervical or thoracic anastomosis after esophagectomy for cancer:a systematic review and meta-analysis.Dig Surg 2011;28:29-35[PMID:21293129 DOI:10.1159/000322014]
4 Sauvanet A,Mariette C,Thomas P,Lozac'h P,Segol P,Tiret E,Delpero JR,Collet D,Leborgne J,Pradère B,Bourgeon A,Triboulet JP.Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction:predictive factors.J Am Coll Surg 2005;201:253-262[PMID:16038824 DOI:10.1016/j.jamcollsurg.2005.02.002]
5 Sunpaweravong S,Ruangsin S,Laohawiriyakamol S,Mahattanobon S,Geater A.Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients.Asian J Surg2012;35:104-109[PMID:22884266 DOI:10.1016/j.asjsur.2012.04.029]
6 Haga Y,Wada Y,Takeuchi H,Ikejiri K,Ikenaga M.Prediction of anastomotic leak and its prognosis in digestive surgery.World J Surg 2011;35:716-722[PMID:21184072 DOI:10.1007/s00268-010-0922-5]
7 Ruteg?rd M,Lagergren P,Rouvelas I,Lagergren J.Intrathoracic anastomotic leakage and mortality after esophageal cancer resection:a population-based study.Ann Surg Oncol 2012;19:99-103[PMID:21769467 DOI:10.1245/s10434-011-1926-6]
8 Van Daele E,Van de Putte D,Ceelen W,Van Nieuwenhove Y,Pattyn P.Risk factors and consequences of anastomotic leakage after Ivor Lewis oesophagectomy?.Interact Cardiovasc Thorac Surg 2016;22:32-37[PMID:26433973 DOI:10.1093/icvts/ivv276]
9 Wright CD,Kucharczuk JC,O'Brien SM,Grab JD,Allen MS;Society of Thoracic Surgeons General Thoracic Surgery Database.Predictors of major morbidity and mortality after esophagectomy for esophageal cancer:a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model.J Thorac Cardiovasc Surg 2009;137:587-595;discussion 596[PMID:19258071 DOI:10.1016/j.jtcvs.2008.11.042]
10 Junemann-Ramirez M,Awan MY,Khan ZM,Rahamim JS.Anastomotic leakage postesophagogastrectomy for esophageal carcinoma:retrospective analysis of predictive factors,management and influence on longterm survival in a high volume centre.Eur J Cardiothorac Surg 2005;27:3-7[PMID:15621463 DOI:10.1016/j.ejcts.2004.09.018]
11 Markar SR,Arya S,Karthikesalingam A,Hanna GB.Technical factors that affect anastomotic integrity following esophagectomy:systematic review and meta-analysis.Ann Surg Oncol 2013;20:4274-4281[PMID:23943033 DOI:10.1245/s10434-013-3189-x]
12 Milstein DM,Ince C,Gisbertz SS,Boateng KB,Geerts BF,Hollmann MW,van Berge Henegouwen MI,Veelo DP.Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy.Medicine(Baltimore)2016;95:e3875[PMID:27336874 DOI:10.1097/MD.0000000000003875]
13 Linder G,Hedberg J,Bj?rck M,Sundbom M.Perfusion of the gastric conduit during esophagectomy.Dis Esophagus 2017;30:143-149[PMID:27766735 DOI:10.1111/dote.12537]
14 Pham TH,Perry KA,Enestvedt CK,Gareau D,Dolan JP,Sheppard BC,Jacques SL,Hunter JG.Decreased conduit perfusion measured by spectroscopy is associated with anastomotic complications.Ann Thorac Surg 2011;91:380-385[PMID:21256274 DOI:10.1016/j.athoracsur.2010.10.006]
15 Tsekov C,Belyaev O,Tcholakov O,Tcherveniakov A.Intraoperative Doppler assessment of gastric tube perfusion in esophagogastroplasty.J Surg Res 2006;132:98-103[PMID:16154594 DOI:10.1016/j.jss.2005.07.037]
16 Alander JT,Kaartinen I,Laakso A,P?til?T,Spillmann T,Tuchin VV,Venermo M,V?lisuo P.A review of indocyanine green fluorescent imaging in surgery.Int J Biomed Imaging 2012;2012:940585[PMID:22577366 DOI:10.1155/2012/940585]
17 Slim K,Nini E,Forestier D,Kwiatkowski F,Panis Y,Chipponi J.Methodological index for nonrandomized studies(minors):development and validation of a new instrument.ANZ J Surg 2003;73:712-716[PMID:12956787 DOI:10.1046/j.1445-2197.2003.02748.x]
18 Kubota K,Yoshida M,Kuroda J,Okada A,Ohta K,Kitajima M.Application of the HyperEye Medical System for esophageal cancer surgery:a preliminary report.Surg Today 2013;43:215-220[PMID:22782594 DOI:10.1007/s00595-012-0251-4]
19 Murawa D,Hünerbein M,Spycha?a A,Nowaczyk P,Po?om K,Murawa P.Indocyanine green angiography for evaluation of gastric conduit perfusion during esophagectomy--first experience.Acta Chir Belg 2012;112:275-280[PMID:23008991 DOI:10.1080/00015458.2012.11680838]
20 Pacheco PE,Hill SM,Henriques SM,Paulsen JK,Anderson RC.The novel use of intraoperative laserinduced fluorescence of indocyanine green tissue angiography for evaluation of the gastric conduit in esophageal reconstructive surgery.Am J Surg 2013;205:349-352;discussion 352-3[PMID:23414958DOI:10.1016/j.amjsurg.2012.11.005]
21 Kumagai Y,Ishiguro T,Haga N,Kuwabara K,Kawano T,Ishida H.Hemodynamics of the reconstructed gastric tube during esophagectomy:assessment of outcomes with indocyanine green fluorescence.World JSurg 2014;38:138-143[PMID:24196170 DOI:10.1007/s00268-013-2237-9]
22 Rino Y,Yukawa N,Sato T,Yamamoto N,Tamagawa H,Hasegawa S,Oshima T,Yoshikawa T,Masuda M,Imada T.Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy.BMC Med Imaging 2014;14:18[PMID:24885891 DOI:10.1186/1471-2342-14-18]
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