Abstract
BackgroundEsophagectomy is the cornerstone in curative treatment for esophageal and gastroesophageal junctional cancer. Esophageal resection is an advanced procedure with many complications, whereof anastomotic leak is the most dreaded. This study aimed to monitor the microcirculation with microdialysis analysis of local lactate levels in real-time on both sides of the esophagogastric anastomosis in totally minimally invasive Ivor-Lewis esophagectomy.Materials and MethodsTwenty-five patients planned for esophageal resection with gastric conduit reconstruction and intrathoracic anastomosis were recruited. A sampling device, the OnZurf® Probe, along with the CliniSenz® Analyser (Senzime AB, Uppsala Sweden) was utilized for measurements. Lactate levels from both sides of the anastomosis were analysed in real time, on site, by a transportable analyser device. Measurements were made every 30 min during the first 24 h, and thereafter every 2 hours for up to 4 days.ResultsAll probes could be positioned as planned and on the third postoperative day 19/25 and 15/25 of the esophageal and gastric probes, respectively, continued to deliver measurements. In total, 89.6% (1539/1718) and 72.4% (1098/1516) of the measurements were deemed successful. The average lactate level on the esophageal side of the anastomosis and the gastric conduit ranged between 1.1–11.5 and 0.8–7.0 mM, respectively. Two anastomotic leaks occurred, one of which had persisting high lactate levels on the gastric side of the anastomosis.ConclusionApplication and use of the novel CliniSenz® analyser system, in combination with the OnZurf® Probe was feasible and safe. Continuous monitoring of analytes from the perianastomotic area has the potential to improve care after esophageal resection.
Highlights
Esophageal cancer and cancer of the gastroesophageal junction (Siewert I and II) is the eight most common type of cancer globally and the incidence rate is rising [1, 2]
Anastomotic leak can be the result of technical error in anastomotic construction or caused by impaired healing, the latter considered to be a result of compromised perfusion of the anastomosis
All patients planned for esophageal resection with gastric conduit reconstruction and intrathoracic anastomosis at a tertiary referral centre were invited to participate in this pilot study
Summary
Esophageal cancer and cancer of the gastroesophageal junction (Siewert I and II) is the eight most common type of cancer globally and the incidence rate is rising [1, 2]. Several attempts to assess the perfusion in the gastric conduit have been made using pulse oximetry [11], doppler flowmetry [12] as well as tonometry [13]. A sampling device, the O nZurf® Probe, along with the C liniSenz® Analyser (Senzime AB, Uppsala Sweden) was utilized for measurements. Lactate levels from both sides of the anastomosis were analysed in real time, on site, by a transportable analyser device. Results All probes could be positioned as planned and on the third postoperative day 19/25 and 15/25 of the esophageal and gastric probes, respectively, continued to deliver measurements. Continuous monitoring of analytes from the perianastomotic area has the potential to improve care after esophageal resection
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