Comparison of Perfusion Level of Gastric Tube During Esophagectomy: Indocyanine Green Fluorescence Imaging Versus Doppler Method.

Abstract

Indocyanine green (ICG) fluorescence imaging has gained popularity for preventing anastomotic leakage (AL), which was previously evaluated using the Doppler method. However, no study has directly compared the use of Doppler and ICG fluorescence imaging simultaneously. When introducing ICG fluorescence imaging in our department, we also used the conventional Doppler method to confirm the validity of its results. We hypothesized that the length of the available gastric tube might differ depending on the evaluation method potentially affecting the risk of AL and the choice of surgical technique. This study evaluated the usefulness of ICG fluorescence imaging and tested this hypothesis. We retrospectively analyzed the data of 248 patients with esophageal cancer who underwent subtotal esophagectomy with gastric tube reconstruction and cervical anastomosis. After excluding 17 cases, 231 patients were included (Doppler-only group, n = 175; Doppler + ICG group, n = 56). In the Doppler + ICG group, changes in the available gastric tube length were evaluated by directly comparing Doppler-based and ICG-based perfusion assessments. To assess the clinical significance of these changes, surgical outcomes, including anastomotic technique and postoperative complications, were compared with those in the Doppler-only group. In the Doppler + ICG group, the available gastric tube length was extended in 37 cases, unchanged in 15 cases, and shortened in 4, showing that extension was significantly more frequent than other changes (p < 0.001). The anastomosis rate with a circular stapler was significantly higher in the Doppler + ICG group (89%) than in the Doppler-only group (61%; p < 0.001). The incidence of Clavien-Dindo grade IIIa AL was significantly lower in the Doppler + ICG group (3.6%) than in the Doppler-only group (15%; p = 0.03). By extending the available gastric tube length, ICG fluorescence imaging was associated with a lower incidence of AL compared with the Doppler method, suggesting it has the potential to improve surgical outcomes and patient safety.