VS03.05: VASCULAR ASSESSMENT OF THE GASTRIC TUBE IN MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY USING INDOCYANINE GREEN

Abstract

Abstract Description One of the major concerns in esophagic surgery is the safety of the esophagogastric anastomosis. Anastomotic leak is associated with important morbidity and mortality. Leak rates have been reported in 4.7% of patients in the Ivor-Lewis procedure and 5.2% for cervical anastomosis. Leak rate has been associated with insufficient vascular supply to the gastric conduit. Indocyanine green (ICG) assessment of the vascularization may be a useful tool to avoid this dreadful complication. Methods A 50-year-old man with medical history of high blood pressure and right pneumothorax was diagnosed of adenocarcinoma of the lower esophagus cT3N3. Neoadjuvant chemo-radiotherapy following CROSS principles was administered. Six weeks after the end of neoadjuvant chemo-radiotherapy a minimally invasive Ivor-Lewis esophagectomy was performed. ICG helped the identification of the right gastroepiploic arcade and of the adequate vascular supply to the gastric conduit. During thoracoscopy, ICG was helpful to assess the vascular supply to the gastric conduit after pull-up into the chest and to check the vascularization of the esophagogastric anastomosis. Results Postoperative evolution was uneventful. Oral intake was resumed on the third postoperative day. Patient was discharged on the 8th postoperative day. Conclusions ICG assessment of the vascularization of the gastric conduit is feasible, safe and helpful in Ivor-Lewis minimally invasive esophagectomy and may decrease the leak rate. Disclosure All authors have declared no conflicts of interest.