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

Figures & data

Figure 1 (A–B). Transserosal microcirculation recordings: (A) microprobe on ventricle surface (B) LCD monitor with the real-time absorption spectrum of oxyhemoglobin (red), and graphic presentation of StO2, relative hemoglobin, flow and velocity and the mean numerical values.

Figure 2 (A–C). Measuring points M1 to M8 (green dots) at baseline, after gastric tube construction, and gastroesophageal anastomosis.

Table 1 Baseline Characteristics of Patients (n=10)

Variables
Median age, years	59 (47–83)
Gender (male: female)	3:7
Comorbidity  Ischemic heart disease  Atrial fibrillation  Stroke  Hypertension  Pulmonary disease  Hypercholesterolemia	0 1 0 5 5 2
BMI, median	24.8 (21.6–31.1)
GERD	7
Smoking	2
Histology  AC/SCC	8/2
Tumor location (Distal Esophagus/Cardia)	9/1
Clinical cancer staging  Stage I  Stage II  Stage III  Stage IV	1 3 5 1
Type of operation  Ivor-Lewis MIE	10
Anastomotic leak
Definition: Type 1	3
Clavien–Dindo classification of surgical complications	I	II	IIIa	IIIb
Anastomotic leak	0	3	0	0
Pneumonia	0	3	0	0
Pleural effusion	0	2	8	0
Atrial fibrillation	0	4	0	0
Pulmonary embolism	0	1	0	0
^aMedian ICU stay, days	4 (4–10)
^bMedian ICU stay, days	4 (4–12)
^aMedian hospital stay, days	25 (25–34)
^bMedian hospital stay, days	17 (7–39)
Mortality  30 days and 90 days	0

Abbreviations: AC, adenocarcinoma; ASA, American Society of Anesthesiologists; BMI, body mass index; GERD, gastroesophageal reflux disease; ICU, intensive care unit; SCC, squamous cell carcinoma; ^aWith leaks; ^bWithout leaks.

Figure 3 (A–D). Mean values with standard deviation of intraoperative transserosal microcirculation of stomach and gastric tube in patients with esophageal cancer. AU, arbitrary units; M1-M7, measuring sites.

Table 2 Results of Intraoperative Transserosal Microcirculation Assessment of Gastric Tube and Thoracic Gastroesophageal Anastomosis with Laser Doppler Flowmetry and Visible Light Spectroscopy in Patients with Esophageal Cancer

Oxygen saturation (AU) (Mean ± SD)				^aMean diff. in %	P	Relative Hemoglobin (AU) (Mean ± SD)			^aMean diff. in %	P
	Baseline	Gastric tube	Anastomosis			Baseline	Gastric tube	Anastomosis
M1^b	69 ± 15	72 ± 27				80 ± 20	78 ± 13
M1^c	87 ± 9	78 ± 22				60 ± 15	63 ± 22
M2^b	88 ± 7	76 ± 33				76 ± 14	58 ± 16
M2^c	88 ± 6	69 ± 21				46 ± 14	65 ± 21
M3^b	84 ± 7	90 ± 1	63 ± 28	25	.26	60 ± 16	81 ± 11	85 ± 35	42	.2
M3^c	90 ± 8	83 ± 8	54 ± 16	40	.005	62 ± 11	62 ± 11	62 ± 23	0	.2
M4^b	82 ± 12	74 ± 21	44 ± 39	46	.16	58 ± 15	77 ± 11	81 ± 21	40	.3
M4^c	91 ± 4	73 ± 16	51 ± 11	44	.005	48 ± 13	51 ± 20	55 ± 27	15	.5
M5^b	93 ± 2	67 ± 13	55 ± 3	41	.005	56 ± 16	69 ± 19	81 ± 10	46	.1
M5^c	89 ± 9	77 ± 17	60 ± 16	33	.005	45 ± 7	9 ± 19	58 ± 36	29	.4
M6^b	85 ± 12	81 ± 16	26 ± 12	69	.01	63 ± 31	62 ± 22	84 ± 6	33	.4
M6^c	86 ± 14	73 ± 16	59 ± 13	32	.005	48 ± 11	56 ± 17	49 ± 16	3	.8
M7^b	87 ± 7	85 ± 14	30 ± 14	66	.005	58 ± 24	47 ± 9	143 ± 77	15	.2
M7^c	90 ± 5	56 ± 29	49 ± 29	46	.01	40 ± 11	78 ± 23	55 ± 19	38	.1
Flow (AU) (Mean ± SD)				^aMean diff. in %	P	Velocity (AU) (Mean ± SD)			^aMean diff. in %	P
	Baseline	Gastric tube	Anastomosis			Baseline	Gastric tube	Anastomosis
M1^b	373 ± 139	290 ± 53				34 ± 11	34 ± 8
M1^c	235 ± 69	237 ± 70				34 ± 6	38 ± 19
M2^b	354 ± 90	313 ± 140				44 ± 14	32 ± 2
M2^c	249 ± 29	252 ± 49				35 ± 7	34 ± 5
M3^b	307 ± 130	414 ± 251	292 ± 16	-5	.9	32 ± 12	50 ± 28	34 ± 6	5	.9
M3^c	249 ± 65	270 ± 82	376 ± 183	51	.9	36 ± 12	38 ± 14	46 ± 15	28	.005
M4^b	305 ± 70	402 ± 190	477 ± 135	57	.3	36 ± 14	43 ± 12	45 ± 5	25	.4
M4^c	258 ± 41	221 ± 63	389 ± 117	51	.02	36 ± 4	30 ± 6	52 ± 9	47	.005
M5^b	294 ± 80	431 ± 219	427 ± 157	45	.1	32 ± 3	43 ± 12	45 ± 10	39	.2
M5^c	227 ± 43	249 ± 66	262 ± 95	15	.4	34 ± 6	36 ± 7	32 ± 11	6	.7
M6^b	263 ± 63	282 ± 173	346 ± 152	32	.5	31 ± 11	31 ± 6	27 ± 3	13	.6
M6^c	208 ± 30	206 ± 59	244 ± 89	17	.4	33 ± 5	33 ± 9	34 ± 12	3	.7
M7^b	266 ± 98	332 ± 157	403 ± 79	52	.2	35 ± 17	41 ± 12	35 ± 5	0	1
M7^c	219 ± 70	233 ± 51	210 ± 27	-4	.8	35 ± 12	32 ± 5	30 ± 4	14	.4

Notes: P values, paired sample t test. ^aPercent changes comparison between Baseline and Anastomosis. ^bWith anastomotic leaks and ^cwithout leaks.

Abbreviation: AU, arbitrary units.