Novel Intraoperative Imaging of Gastric Tube Perfusion during Oncologic Esophagectomy—A Pilot Study Comparing Hyperspectral Imaging (HSI) and Fluorescence Imaging (FI) with Indocyanine Green (ICG)

Sebastian Hennig,Hannes Köhler,Ines Gockel,Jana Hoffmann,Marianne Maktabi,Luise Knospe,Annekatrin Pfahl,Boris Jansen-Winkeln,Yusef Moulla,Stefan Kwast,Claire Chalopin

doi:10.3390/cancers14010097

Sebastian Hennig, Hannes Köhler + Show 9 more

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https://doi.org/10.3390/cancers14010097

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Abstract

Simple SummaryOncologic esophagectomy with gastric conduit reconstruction is the gold standard in the curative treatment of localized esophageal cancer. Anastomotic leakage is one of the most significant postoperative complications and a predictor of increased postoperative mortality and deteriorated quality of life. Adequate perfusion is one of the essential prerequisites for anastomotic healing. An objective evaluation of the perfusion of the gastric conduit can be performed by hyperspectral imaging (HSI) and fluorescence imaging (FI) with indocyanine green (ICG) intraoperatively. The aim of this pilot study was to evaluate the feasibility and the potential of improved outcomes by simultaneous HSI and FI-ICG measurements of the gastric tube during esophagectomy.Background: Novel intraoperative imaging techniques, namely, hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, thus increasing patient safety. Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. To our knowledge, this is the first study evaluating both modalities simultaneously during esophagectomy. Methods: In our pilot study, 13 patients, who underwent Ivor Lewis esophagectomy and gastric conduit reconstruction, were analyzed prospectively. HSI and FI were recorded before establishing the anastomosis in order to determine its optimum position. Results: No anastomotic leak occurred during this pilot study. In five patients, the imaging methods resulted in a more peripheral adaptation of the anastomosis. There were no significant differences between the two imaging tools, and no adverse events due to the imaging methods or indocyanine green (ICG) injection occurred. Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming. They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort.

Highlights

Oncologic esophagectomy is the cornerstone treatment of locally or locally advanced esophageal cancer
Only a few clinical studies have attempted to quantify the fluorescence imaging (FI)-indocyanine green (ICG) signal based on the time course after dye injection, and no gold standard has been established to date
We demonstrated that Hyperspectral Imaging (HSI) and FI-ICG are comparable with complementary value added and that it is practicable to combine both methods in the clinical routine of oncologic esophagectomy

Summary

Introduction

Oncologic esophagectomy is the cornerstone treatment of locally or locally advanced esophageal cancer. In previous studies and clinical practice, evaluation of gastric conduit perfusion has been assessed on the surgeons’ subjective experience only, a controversial issue that has been discussed [10,11]. Hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, increasing patient safety Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort

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