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Society for Surgery of the Alimentary Tract

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Yoshitaka Ishikawa*, Katsunori Nishikawa, Keita Takahashi, Takanori Kurogochi, Masami Yuda, Yujiro Tanaka, Akira Matsumoto, Yuichiro Tanishima, Norio Mitsumori, Katsuhiko Yanaga
Surgery, The Jikei University, Tokyo, Japan

[Introduction] Esophagectomy reconstruction is one of the most challenging surgical procedures, and has a higher incidence of complications such as anastomotic leakage (AL) than other gastrointestinal operations. Impaired blood flow of the esophageal substitute is considered as a main risk factor for AL. The aim of this study is to evaluate the indication and feasibility of an additional revascularization to the gastric conduit in esophageal cancer surgery.
[Patients and Methods] A total of 240 patients (mean age 66 [37-83] years, male: female = 204: 36) who underwent esophagectomy with a gastric conduit reconstruction from July 2008 to October 2018 were enrolled in this retrospective study. All patients were eligible for intraopearative evaluation of blood flow of the gastric conduit by a thermal imaging. Anastomotic viability index (AVI) was specifically calculated to quantitatively estimate hemodynamics of the conduit. Additional microvascular anastomosis (MA) was added in patients with low AVI score who were clinically at high risk for poor vascularization such as neoadjuvant radiotherapy, a long history of steroid use, or poorly controlled diabetes mellitus.
[Results] AL and in-hospital mortality occurred in 20 (8%) and 5 (2%) of patients, respectively. The median postoperative hospital stay was 24 (13-245) days. MA was added in 23 patients (10%). Comparison between MA and non-MA showed significant differences in mean AVI score, operation time and preoperative radiation therapy (p<0.05 each). There was no statistical difference between MA and non-MA in AL (1 vs. 19, p=0.47) or the median postoperative hospital stay (22 vs. 24 days, p=0.48).
[Discussion] MA can be performed without worsening short-term outcome in spite of longer operation time. AVI can be an objective parameter of blood flow of the gastric conduit. Additional MA may improve development of AL caused by poor vascularization of the conduit and delayed anastomotic healing.

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