Abstract
The aim of the present study was to evaluate the safety of mediastinal microdialysis and its efficacy regarding the early diagnosis of anastomotic leakage after gastroesophageal resection for esophageal cancer. Eight consecutive patients were included; one patient was excluded for reasons of catheter malfunction. The tip of the mediastinal microdialysis catheter was placed close to the anastomosis and held by a 4-0 absorbable suture. A subcutaneous microdialysis catheter placed in the pectoral region served as a reference. Samples collected every 4 h in the first 8 postoperative days were analyzed for lactate, glucose, pyruvate, and glycerol and the lactate/pyruvate ratio (L/P ratio) was calculated. There were no procedure-related complications. Six patients had an uncomplicated postoperative course. In one patient, the L/P ratio was within normal range during the first 20 h postoperatively, but a steady and significant increase in L/P ratio then occurred, reaching a maximum of 105 after 124 h. The patient developed leakage symptoms on day 3, but endoscopy was unable to demonstrate any leakage. On the sixth postoperative day, blue dye administered through the nasogastric tube was recovered in the pleural drain. The leakage was treated with a covered selfexpanding metal stent; an immediate and significant drop in the L/P ratio occurred. Mediastinal microdialysis seems to be a safe and promising tool in the early diagnosis of anastomotic leakage in patients undergoing gastroesophageal resection for cancer.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004;10:71–75.
Beitler AL, Urschel JD. Comparison of stapled and hand-sewn esophagogastric anastomoses. Am J Surg 1998;175:337–340.
Griffin SM, Lamb PJ, Dresner SM, Richardson DL, Hayes N. Diagnosis and management of a mediastinal leak following radical oesophagectomy. Br J Surg 2001;88:1346–1351.
Patil PK, Patel SG, Mistry RC, Deshpande RK, Desai PB. Cancer of the esophagus: esophagogastric anastomotic leak. A retrospective study of predisposing factors. J Surg Oncol 1992;49:163–167.
Pross M, Manger T, Reinheckel T, Mirow L, Kunz D, Lippert H. Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest. Endosc 2000;51:73–76.
Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005;61:891–896.
Marshall JC, Maier RV, Jimenez M, Dellinger EP. Source control in the management of severe sepsis and septic shock: an evidencebased review. Crit Care Med 2004;32:S513–S526.
Jansson K, Ungerstedt J, Jonsson T, Redler B, Andersson M, Ungerstedt U, Norgren L. Human intraperitoneal microdialysis: increased lactate/pyruvate ratio suggests early visceral ischaemia. A pilot study. Scand J Gastroenterol 2003;38:1007–1011.
Jansson K, Strand I, Redler B, Magnuson A, Ungerstedt U, Norgren L. Results of intraperitoneal microdialysis depend on the location of the catheter. Scand J Clin Lab Invest 2004;64:63–70.
Jansson K, Redler B, Truedsson L, Magnuson A, Ungerstedt U, Norgren L. Postoperative on-line monitoring with intraperitoneal microdialysis is a sensitive clinical method for measuring increased anaerobic metabolism that correlates to the cytokine response. Scand J Gastroenterol 2004;39:434–439.
Jansson K, Jansson M, Andersson M, Magnuson A, Ungerstedt U, Norgren L. Normal values and differences between intraperitoneal and subcutaneous microdialysis in patients after non-complicated gastrointestinal surgery. Scand J Clin Lab Invest 2005;65:273–281.
Klaus S, Heringlake M, Gliemroth J, Bruch HP, Bahlmann L. Intraperitoneal microdialysis for detection of splanchnic metabolic disorders. Langenbecks Arch Surg 2002;387:276–280.
Korth U, Krieter H, Denz C, Janke C, Ellinger K, Bertsch T, Henn C, Klein J. Intestinal ischaemia during cardiac arrest and resuscitation: comparative analysis of extracellular metabolites by microdialysis. Resuscitation 2003;58:209–217.
Norgren L, Jansson K. Intraperitoneal and intraluminal microdialysis in the detection of experimental regional intestinal ischaemia. Br J Surg 2004;91:855–861.
Ungerstedt J, Nowak G, Ericzon BG, Ungerstedt U. Intraperitoneal microdialysis (IPM): a new technique for monitoring intestinal ischemia studied in a porcine model. Shock 2003;20:91–96.
Sommer T, Larsen JF. Intraperitoneal and intraluminal microdialysis in the detection of experimental regional intestinal ischaemia. Br J Surg 2004;91:855–861.
Ungerstedt U. Microdialysis: principles and applications for studies in animals and man. J Intern Med 1991;230:365–373.
Hovendal CP, Bech K, Gottrup F, Andersen D. Adrenergic influence on gastric mucosal blood flow in gastric fistula dogs. Scand J Gastroenterol Suppl 1984;89:41–44.
Neviere R, Mathieu D, Chagnon JL, Lebleu N, Wattel F. The contrasting effects of dobutamine and dopamine on gastric mucosal perfusion in septic patients. Am J Respir Crit Care Med 1996;154:1684–1688.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pedersen, M.E., Mortensen, M.B., Qvist, N. et al. Mediastinal microdialysis: early diagnosis of anastomotic leakage after resection for esophageal cancer. Esophagus 6, 63–66 (2009). https://doi.org/10.1007/s10388-008-0179-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-008-0179-3