Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis

Ladak, Farah; Dang, Jerry; Switzer, Noah; Mocanu, Valentin; Tian, Chunjie; Birch, Daniel W.; Turner, Simon R.; Karmali, Shahzeer

doi:10.1007/s00464-018-6503-7

Cited by 118 publications

(59 citation statements)

References 47 publications

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“…Technical improvements like ischemic conditioning of the gastric conduit before esophagectomy [45] as well as intraoperative indocyanine fluorescence are promising and have been reported to improve tissue perfusion. The latter still needs randomized, multicenter trials to proof the benefit [46]. Additionally, minimal invasive procedures might reduce the perioperative trauma.…”

Section: Discussionmentioning

confidence: 99%

Diltiazem Prophylaxis for the Prevention of Atrial Fibrillation in Patients Undergoing Thoracoabdominal Esophagectomy: A Retrospective Cohort Study

et al. 2020

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Background Atrial fibrillation (AF) represents the most frequent arrhythmic disorder after thoracoabdominal esophageal resection and is associated with a significant increase in perioperative morbidity and mortality.Methods In this retrospective cohort study, 167 patients who underwent thoracoabdominal esophagectomy at a large university hospital were assessed. We compared patients who received a 14-day postoperative course of diltiazem with a control group of patients who did not undergo diltiazem prophylaxis. Diltiazem therapy started immediately upon admission to the intensive care unit (ICU) with a loading dose of 0.25 mg/kg bodyweight (i.v.) followed by continuous infusion (0.1 mg/kg bodyweight/h) for 40-48 h. Oral administration (Dilzem Ò 180 mg uno retard, once a day) was started on postoperative day 3. Results A total of 117 patients were assessed. Twelve (10.3%) of all patients developed postoperative new-onset atrial fibrillation in the first 30 days after surgical intervention. Prevalence of new-onset AF showed no significant differences between the diltiazem group and control group (p = 0.74). The prevalence of bradycardia (14.7% vs. 3.6%; p = 0.03) and dose of norepinephrine required (0.09 vs. 0.04 lg/kg bodyweight/min; p = 0.04) were higher in the diltiazem group. There were no significant differences between the groups for the median postoperative duration of hospital/ICU stay or mortality. Conclusions A prophylactic 14-day postoperative course of diltiazem was not associated with a reduction in newonset AF or 30-day mortality following thoracoabdominal esophagectomy. Prophylactic diltiazem therapy was associated with drug-related adverse effects such as bradycardia and increased requirement of norepinephrine. German Clinical Trial Registration Number: DKRS00016631.

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Section: Discussionmentioning

confidence: 99%

Diltiazem Prophylaxis for the Prevention of Atrial Fibrillation in Patients Undergoing Thoracoabdominal Esophagectomy: A Retrospective Cohort Study

et al. 2020

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“…Poor quality was mainly due to absence of a non-exposed cohort. Furthermore, a meta-analysis by Ladak et al was recently published on fluorescence angiography to assess the perfusion of the gastric conduit (36). In this review we identified two extra articles, not including a non-exposed cohort (12,19).…”

Section: Discussionmentioning

confidence: 99%

Fluorescent imaging using indocyanine green during esophagectomy to prevent surgical morbidity: a systematic review and meta-analysis

et al. 2019

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Background: Fluorescent imaging using indocyanine green (ICG) is an emerging technique that aids the surgeon with intraoperative decision making during upper gastrointestinal cancer surgery. In this systematic review we aim to provide an overview of current practice of fluorescence imaging using ICG during esophagectomy, and to show how this technology can prevent surgical morbidity, such as anastomotic leakage, graft necrosis and chylothorax. Methods: The PRISMA standard for systematic reviews was used. The PubMed and Embase database were searched to identify articles matching our systematic literature search. Two authors screened all included articles for eligibility. Risk of bias was assessed for all included articles. Results: A total of 25 articles were included in this review: 22 articles on perfusion assessment, and three on the detection of chyle fistula. Five out of 22 articles concerning perfusion assessment evaluated fluorescence signals in quantitative values. In 20 articles the pooled incidence of anastomotic leakage and graft necrosis in the ICG group was 11.10% (95% CI: 8.06-15.09%) and in eight studies the pooled change in management rate was 24.55% (95% CI: 19.16-30.88%). After change in management, the pooled incidence of anastomotic leakage and graft necrosis was 14.08% (95% CI: 6.55-27.70%). A meta-analysis showed that less anastomotic leakages and graft necrosis occur in the ICG group (OR 0.30, 95% CI: 0.14-0.63). Three case-reports (N=3) were identified regarding chyle fistula detection, and ICG lymphography detected the thoracic duct in all cases and the chyle fistula in one case. Conclusions: Fluorescence imaging using ICG is a promising and safe technology to reduce surgical morbidity after esophagectomy with continuity restoration. ICG fluorescence angiography showed a reduction in anastomotic leakage and graft necrosis. Future studies are needed to demonstrate the feasibility of ICG lymphography for chyle fistula detection.

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“…Using ; the greater omentum is then divided and dissection proceeds along the short gastric vessels (C); once the left crus is defined, the stomach is rotated and retrogastric attachments are divided (D); the gastrohepatic ligament is divided (E) and the right crus is defined; a 4-5 cm gastric conduit is created (F) with serial firing of staplers (G); indocyanine green can be used to define the vascularity of the conduit (H); finally, a jejunostomy feeding tube is placed in the left lower quadrant (I) prior to abdominal closure the near-infrared imaging mode on the robotic console, indocyanine green (ICG) may be administered intravenously (IV) to define the vascularity of the conduit [ Figure 1H]. The literature is equivocal on the use of ICG, as there is no conclusive evidence demonstrating decreased anastomotic leak rates with this strategy [17,18] . We typically use 5 mg of ICG injected IV by the anesthesia team followed by a saline flush.…”

Section: Abdominal Portion Of the Proceduresmentioning

confidence: 99%

Robotic esophagectomy: how I do it?

Khaitan¹,

Lazar²,

Margolis³

et al. 2020

Mini-invasive Surg

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Compared to the open approach, minimally invasive esophagectomy (MIE) offers several advantages including smaller incisions with decreased pain, improved cosmesis, and earlier return of the patient to baseline function. Robotic-assisted minimally invasive esophagectomy (RAMIE) builds on standard MIE by offering threedimensional visualization, better instrument articulation, tremor filtration, and superior ergonomics, all of which facilitate technical precision and surgeon comfort. An evolving literature demonstrates that when performed by experienced surgeons, RAMIE leads to improved perioperative outcomes with long-term oncologic equivalency to open approaches, and may offer advantages compared to traditional MIE. This review focuses on the key steps of performing 3-field McKeown, 2-field Ivor Lewis, and transhiatal robotic esophagectomies, data regarding the short-and long-term outcomes, and a brief overview of upcoming trials comparing RAMIE with MIE.

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Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis

Cited by 118 publications

References 47 publications

Diltiazem Prophylaxis for the Prevention of Atrial Fibrillation in Patients Undergoing Thoracoabdominal Esophagectomy: A Retrospective Cohort Study

Diltiazem Prophylaxis for the Prevention of Atrial Fibrillation in Patients Undergoing Thoracoabdominal Esophagectomy: A Retrospective Cohort Study

Fluorescent imaging using indocyanine green during esophagectomy to prevent surgical morbidity: a systematic review and meta-analysis

Robotic esophagectomy: how I do it?

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