Our Summary

This research paper is about a study that looked at the use of a specific technology - indocyanine green fluorescence angiography (ICG-FA) - in a type of minimally invasive surgery to remove part or all of the esophagus (the tube that connects the throat to the stomach). This surgery is known as Ivor Lewis esophagectomy.

One of the risks with this kind of surgery is an ‘anastomotic leak’, which is when the place where the surgeon has joined the remaining part of the esophagus to another part of the digestive tract starts to leak fluids.

The researchers were interested to see if using ICG-FA - which allows the surgeon to see in real-time how well blood is flowing to the areas being operated on - could help to reduce the risk of anastomotic leaks.

They found that patients who had a leak were more likely to be overweight, have diabetes and lose more blood during the operation. They also found that leaks were more likely if there was a problem with the blood flow to the part of the digestive tract that the surgeon was joining to the esophagus.

The researchers concluded that ICG-FA could be a useful tool to help surgeons prevent leaks. However, they also stressed that other factors are involved in whether or not a leak occurs, and that further research is needed to confirm their findings and understand how best to use this new technology in this type of surgery.

FAQs

  1. What is indocyanine green fluorescence angiography (ICG-FA) and how is it used in Ivor Lewis esophagectomy?
  2. What factors were found to increase the likelihood of an anastomotic leak during this surgery?
  3. What were the researchers’ conclusions about the effectiveness of ICG-FA in preventing anastomotic leaks during Ivor Lewis esophagectomy?

Doctor’s Tip

A doctor might advise a patient undergoing esophagectomy to maintain a healthy weight, manage diabetes effectively, and discuss with their surgeon about using ICG-FA technology during the surgery to reduce the risk of anastomotic leaks. It is important to follow all pre and post-operative instructions provided by the healthcare team to ensure a successful recovery.

Suitable For

Patients who are typically recommended for esophagectomy include those with esophageal cancer, Barrett’s esophagus, esophageal strictures, and other conditions that affect the esophagus. Patients who have not responded to other treatments such as medication or endoscopic therapy may also be recommended for esophagectomy.

Additionally, patients who are in good overall health and able to tolerate surgery and the recovery process are typically considered for esophagectomy. It is important for patients to have a thorough evaluation by their healthcare team to determine if they are suitable candidates for this type of surgery.

Overall, the decision to recommend esophagectomy is based on a variety of factors including the patient’s overall health, the stage and extent of the disease, and the potential benefits and risks of the surgery. Each patient’s case is unique, and a multidisciplinary team of healthcare professionals will work together to determine the best treatment plan for each individual.

Timeline

Before the esophagectomy:

  • Patient is diagnosed with a condition requiring removal of part or all of the esophagus
  • Patient undergoes pre-operative testing and evaluation
  • Patient receives counseling and education about the surgery and post-operative care
  • Surgery is scheduled

After the esophagectomy:

  • Patient undergoes the minimally invasive surgery, Ivor Lewis esophagectomy
  • Surgeon uses ICG-FA technology to monitor blood flow during the operation
  • Patient is monitored closely in the post-operative period for signs of complications, including anastomotic leaks
  • If a leak occurs, patient may require additional treatment or surgery
  • Patient undergoes post-operative rehabilitation and recovery
  • Patient is followed up with regular check-ups and testing to monitor long-term outcomes and complications.

What to Ask Your Doctor

  1. What is the purpose of using indocyanine green fluorescence angiography (ICG-FA) in my esophagectomy surgery?
  2. How does ICG-FA help to reduce the risk of anastomotic leaks during the surgery?
  3. Are there any specific risks or complications associated with using ICG-FA in this type of surgery?
  4. How experienced are you and your team in using ICG-FA for esophagectomy surgeries?
  5. What are the potential benefits of using ICG-FA in my specific case?
  6. Are there any alternative techniques or technologies that could be used instead of ICG-FA for this surgery?
  7. How likely am I to experience an anastomotic leak without the use of ICG-FA?
  8. How will I know if there is a leak following the surgery, and what are the treatment options if a leak occurs?
  9. What is the recovery process like for patients who have had an esophagectomy with the use of ICG-FA?
  10. Are there any long-term implications or considerations I should be aware of if I undergo this surgery with the use of ICG-FA?

Reference

Authors: Pather K, Deladisma AM, Guerrier C, Kriley IR, Awad ZT. Journal: Surg Endosc. 2022 Feb;36(2):896-903. doi: 10.1007/s00464-021-08346-9. Epub 2021 Feb 12. PMID: 33580319