Efficacy of near-infrared fluorescence imaging in minimally invasive esophagectomy
- VernacularTitle:近红外荧光显影技术在微创食管癌根治术中的疗效
- Author:
Zhuoqi JIA
1
,
2
;
Jizhao WANG
1
;
Junke FU
1
;
Guangjian ZHANG
1
Author Information
1. Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China
2. Department of Thoracic Surgery, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, 710004, P. R. China
- Publication Type:Journal Article
- Keywords:
Esophageal carcinoma;
minimally invasive esophagectomy;
indocyanine green;
near-infrared fluorescence imaging;
anastomotic leakage
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(10):1626-1633
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the short-term outcomes of near-infrared fluorescence imaging (NIRF) technique in minimally invasive McKeown esophagectomy for esophageal cancer. Methods Patients who consecutively underwent minimally invasive McKeown esophagectomy for esophageal cancer performed by a single surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, between July 2020 and December 2023 were included. Patients were categorized into an NIRF group and a control group based on whether NIRF was employed to assess gastric conduit blood flow. We compared the clinical characteristics, operative parameters, major postoperative complications, and short-term quality of life between the two groups. Results A total of 246 patients were included. The NIRF group comprised 132 patients (85 males, 47 females) with a mean age (62.6±6.7) years, and the control group included 114 patients (78 males, 36 females) with a mean age (64.4±3.8) years. There were no significant differences in operative time, intraoperative blood loss, number of harvested lymph nodes, or hospital stay between the two groups (P>0.05). Similarly, the rates of recurrent laryngeal nerve injury or cardiopulmonary complications did not differ significantly between the groups (P>0.05). No chylothorax or 90-day mortality occurred in either group. Anastomotic leakage occurred in 5 (3.79%) patients in the NIRF group and 9 (7.89%) patients in the control group. The difference in anastomotic leakage rates was not statistically significant (P=0.098), showing only a trend towards a lower incidence in the NIRF group. Receiver operating characteristic curve analysis indicated that maximum fluorescence intensity (MFI) was correlated with gastric conduit perfusion, with an MFI of 20.5 identified as the cutoff value for predicting anastomotic leakage (P=0.039). Further analysis showed that in the NIRF group, an indocyanine green fluorescence imaging time >95 s and a blood flow velocity <1.7 cm/s were significantly associated with an increased risk of anastomotic leakage (P<0.05). The SF-36 quality of life score at 3 months postoperatively was significantly better in the NIRF group than in the control group (P<0.001); however, there was no significant difference in scores between the two groups at 12 months postoperatively (P=0.704). Conclusion In minimally invasive esophagectomy for esophageal cancer, NIRF can effectively assess gastric conduit blood perfusion using quantitative parameters, demonstrates a trend towards reducing anastomotic leakage rates, and contributes to accelerated early postoperative recovery and improved short-term quality of life.
