Mediastinal microdialysis: early diagnosis of anastomotic leakage after resection for esophageal cancer

Abstract

The aim of the present study was to evaluate the safety of mediastinal microdialysis and its effi cacy regarding the early diagnosis of anastomotic leakage after gastroesophageal resection for esophageal cancer. Eight consecutive patients were included; one patient was excluded for reasons of catheter malfunction. The tip of the mediastinal microdialysis catheter was placed close to the anastomosis and held by a 4-0 absorbable suture. A subcutaneous microdialysis catheter placed in the pectoral region served as a reference. Samples collected every 4 h in the fi rst 8 postoperative days were analyzed for lactate, glucose, pyruvate, and glycerol and the lactate/pyruvate ratio (L/P ratio) was calculated. There were no procedure-related complications. Six patients had an uncomplicated postoperative course. In one patient, the L/P ratio was within normal range during the fi rst 20 h postoperatively, but a steady and signifi cant increase in L/P ratio then occurred, reaching a maximum of 105 after 124 h. The patient developed leakage symptoms on day 3, but endoscopy was unable to demonstrate any leakage. On the sixth postoperative day, blue dye administered through the nasogastric tube was recovered in the pleural drain. The leakage was treated with a covered selfexpanding metal stent; an immediate and signifi cant drop in the L/P ratio occurred. Mediastinal microdialysis seems to be a safe and promising tool in the early diagnosis of anastomotic leakage in patients undergoing gastroesophageal resection for cancer.

Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery

“…Crucially, in three patients with a leak delayed beyond 10 days, the increases in lactate and lactate/pyruvate ratios were observed several days before the leak became clinically apparent. Similar findings were recorded following oesophageal cancer resection [62]. The microdialysis method allowed for rapid analysis at multiple time points.…”

Microdialysis in Postoperative Monitoring of Gastrointestinal Organ Viability: A Systematic Review

“…Mediastinal microdialysis was performed in two studies on patients undergoing esophageal resection due to malignancy [9, 10]. The first study included seven patients, one of which developed anastomotic leakage.…”

“…All studies were prospective cohort studies. The included studies comprised 12 studies on upper gastrointestinal tract surgery including liver and pancreatic surgery [8][9][10][11][12][13][14][15][16][17][18][19], 5 studies on bowel surgery [21][22][23][24][25], 3 studies on pediatric surgery [26][27][28], 3 studies on acute surgery and/or admission to the intensive care unit (ICU) [7,29,30], and 3 studies on a mixed study population [31][32][33]. The number of patients included in the studies ranged from 7 to 91.…”