LAUSR

Evaluation of the blood supply to gastric conduits is critically important to avoid complications following esophagectomy. We commenced visualized evaluation of blood flow using indocyanine green (ICG) fluorescent imaging from July 2015, to reduce reconstructive complications. In this study, we aimed to statistically verify the efficacy of blood flow evaluation using our simplified ICG method. We analysed and compared two groups, those before and after introduction of ICG evaluation. We performed propensity score matching (PS-M), compared clinical outcomes and analysed how the visualized evaluation reduced the risk of complications. Sixty-eight matched pairs were analysed. The leakage rate in the ICG group was significantly lower than the non-ICG group for each severity grade both in the entire cohort (285 subjects) and after PS-M, while the rate of other major complications, including recurrent laryngeal nerve (RLN) palsy and pneumonia, were not different between the two groups in the entire cohort and after PS-M. The duration of postoperative intensive care unit (ICU) stay was approximately one day shorter in the ICG than the non-ICG group in the entire cohort, and approximately two days shorter after PS-M. Visualized evaluation of blood flow with ICG methods significantly reduced the rate of anastomotic complications of all Clavien-Dindo (CD) severity grades. Odds ratio with ICG evaluation decreased with CD grade (0.3419 for CD ≥ 1, 0.241 for CD ≥ 2 and 0.2153 for CD ≥ 3). Objective evaluation of blood supply to the reconstructed conduit using ICG fluorescent imaging reduces the risk and degree of anastomotic complication. All authors have declared no conflicts of interest.