Laser Doppler Flowmetry and Visible Light Spectroscopy of the Gastric Tube During Minimally Invasive Esophagectomy

Abstract

Introduction

Ischemia is considered as the main reason for thoracic gastroesophageal anastomotic leaks after esophagectomy. Microcirculatory monitoring with laser Doppler flowmetry and visible light spectroscopy may provide valuable intraoperative real-time information about the gastric tube’s tissue perfusion and circulation.

Patients and Methods

Ten patients with esophageal cancer operated with minimally invasive esophagectomy participated in this single-center, prospective, observational pilot study. A single probe with laser Doppler flowmetry and visible light spectroscopy was used to perform transserosal microcirculation assessment of the gastric tube at predefined anatomical sites during different operation phases. Group comparison and changes were evaluated using the paired sample t-test.

Results

A reduction in StO2 was found at all measuring sites after the gastric tube formation compared with the baseline measurements. The mean StO2 reduction from baseline to gastric tube formation and after anastomosis was 16% (range 4%–28%) and 42% (range, 35%–52%), respectively. A statistically significant increase in the rHb concentration, representing venous congestion, was detected at the most cranial part of the gastric tube (P = 0.04). Three patients developed anastomotic leaks.

Conclusion

Intraoperative real-time laser Doppler flowmetry and visible light spectroscopy are feasible and may provide insight to microcirculatory changes in the gastric tube and at the anastomotic site. Patients with anastomotic leaks seem to have critical local tissue StO2 reduction and venous congestion that should be further evaluated in studies with larger sample sizes.

Keywords:

• esophagectomy
• gastric tube circulation
• gastroesophageal anastomosis complications

Data Sharing Statement

Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures), will be made available and shared with investigators whose proposed use of the data has been approved, but an independent review committee identified for this purpose. Proposals should be directed to associate professor Syed Sajid Hussain Kazmi MD Ph.D. [email protected], project leader. To gain access, data requesters will need to sign a data access agreement.

Acknowledgment

We are thankful for the kind assistance of Mrs. Hilde Iren Flaatten, University medical library, Oslo University Hospital and Mrs. Manuela Zucknick, Associate professor, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo.

Disclosure

The authors have nothing to disclose.