Objective

We determined the anastomotic site during gastric tube reconstruction in esophagectomy according to the "90-to 60-s rule" using indocyanine green (ICG) fluorescence angiography. We evaluated its safety and efficacy in a prospective multicenter setting.

Methods

We enrolled 129 patients who underwent subtotal esophagectomy for esophageal cancer. ICG fluorescence angiography was performed after making a wide gastric tube, and the time from the initial enhancement of the right gastroepiploic artery to the tip of the gastric tube was used as a parameter. Esophago-gastro anastomosis was made at the area that was enhanced within 90 s (preferably within 60 s). The enhancement time and the incidence of anastomotic leakage were compared.

Results

In all cases, anastomosis was made at the site enhanced within 90 s. Anastomotic leakage was found in only 4 (3.1%) of 129 cases; specifically, it was detected in 3 (2.4%) of 126 cases whose anastomotic site was enhanced within 60 s and in 1 (33.3%) of 3 cases where the enhancement time exceeded 60 s (p = 0.09).

Conclusions

Determining the anastomotic site using the 90-to 60-s rule with ICG imaging in gastric tube reconstruction helps reduce the rate of anastomotic leakage.

中文翻译：

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吲哚菁绿荧光血管造影评估食管切除术中胃管血流量的多中心前瞻性研究

客观的

我们根据“90 至 60 秒规则”使用吲哚菁绿 (ICG) 荧光血管造影术确定了食管切除术中胃管重建过程中的吻合​​部位。我们在前瞻性多中心环境中评估了其安全性和有效性。

方法

我们招募了 129 名因食管癌而接受食管次全切除术的患者。制作宽胃管后进行ICG荧光血管造影，以右胃网膜动脉初始强化至胃管尖端的时间为参数。在90 s内（最好在60 s内）增强的区域进行食管-胃吻合。比较强化时间和吻合口漏发生率。

结果

在所有情况下，在 90 秒内增强的部位进行吻合。129 例中仅 4 例（3.1%）发现吻合口漏；具体而言，在 60 s 内增强的 126 例病例中有 3 例（2.4%）和在增强时间超过 60 s 的 3 例病例中有 1 例（33.3%）（p  = 0.09）。

结论

在胃管重建中使用 90 到 60 秒规则和 ICG 成像确定吻合部位有助于降低吻合口漏率。