The novel use of intraoperative laser-induced fluorescence of indocyanine green tissue angiography for evaluation of the gastric conduit in esophageal reconstructive surgery.

BACKGROUND: Esophagectomy with reconstruction using a gastric conduit is associated with a relatively high rate of anastomotic leakage. We used indocyanine green tissue angiography to evaluate the gastric conduit intraoperatively before gastroesophageal anastomosis to identify ischemia. METHODS: We performed an institutional review board–approved retrospective review of all esophagectomies performed from 2010 to the beginning of 2011. Patient histories and perioperative outcomes were reviewed retrospectively. Postoperative morbidity and 30-day mortality were determined. RESULTS: Eleven patients had an esophagectomy performed using this technology. All had adequate perfusion on gross examination. All but 1 had good perfusion with tissue angiography, and there were 2 anastomotic leakages leaks including this patient. There were no mortalities at 30 days. CONCLUSIONS: We report preliminary results using this imaging system in esophageal reconstructive surgery. Larger randomized controlled studies are needed to determine if surgical outcomes can be improved using this technology. 2013 Elsevier Inc. All rights reserved. In 2010, an estimated 16,640 patients in the United States were diagnosed with esophageal cancer with over 14,500 deaths from the disease. For those with resectable disease, surgery offers the best chance for a cure. The choice of procedure is based on tumor location, adherence to surrounding tissues, and surgeon preference. Our preferred approach to lower esophageal tumors is a transhiatal approach with conversion to a 3-hole esophagectomy