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Wider Gastric Conduit Morphology Is Associated with Improved Blood Flow During Esophagectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

It remains unclear what is the ideal conduit shape. The aim of this study was to evaluate association between specific gastric conduit morphology, considering width and length, with its perfusion and the incidence of anastomotic leaks after esophagectomy.

Methods

Patients who underwent an esophagectomy with cervical esophagogastric anastomosis between 2015 and 2021 were evaluated. Indocyanine green angiography was performed to evaluate gastric conduit perfusion, and ingress index (arterial inflow) and ingress time (venous outflow) were measured. The conduit width at the middle of the conduit and the short gastric length as the length from the last gastroepiploic branch to the perfusion assessment point were measured. Propensity score matching was performed to compare wide conduits with narrow conduits. Narrow and wide conduits were defined as < 4 and ≥ 5 cm, respectively.

Results

Three hundred fifty-eight patients were reviewed. After applying matching, the wide conduits had higher ingress index (48.2 vs 33.3%, p < 0.001) and shorter ingress time (51.2 vs 66.3 s, p = 0.004) compared to the narrow conduits. Including the short gastric length in analysis, creating a wide conduit is a significant factor for better ingress index (p = 0.001), especially when the perfusion assessment point is 5 cm or farther from the last gastroepiploic branch. Anastomotic leaks did not differ between the groups.

Conclusions

Conduit width is a significant factor of gastric conduit perfusion, especially when the estimated anastomotic site was > 5 cm from the last gastroepiploic branch. Wide conduits seem to have better perfusion and creating a wider conduit might reduce anastomotic leaks.

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Fig. 1
Fig. 2

© system generates the perfusion images, but also this graph in real time. An ingress triangle is automatically drawn based on the “inflow” of ICG dye and then values are provided as a target region is set

Fig. 3
Fig. 4

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Authors and Affiliations

  1. Section of Thoracic Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Yoshitaka Ishikawa, Andrew C. Chang, Jules Lin, Mark B. Orringer, William R. Lynch, Kiran H. Lagisetty & Rishindra M. Reddy

  2. Division of Thoracic Surgery, University of Toronto, 149 College Street, ON, M5T 1P5, Toronto, Canada

    Elliot Wakeam

Authors
  1. Yoshitaka Ishikawa
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  2. Andrew C. Chang
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Contributions

• Yoshitaka Ishikawa: conceptualization, methodology, investigation, formal analysis, resources, data curation, visualization, writing—original draft, writing—review and editing.

• Andrew C. Chang: methodology, investigation, data curation, writing—review and editing.

• Jules Lin: methodology, investigation, data curation, writing—review and editing.

• Mark B. Orringer: methodology, investigation, data curation, writing—review and editing.

• William R. Lynch: methodology, investigation, data curation, writing—review and editing.

• Kiran H. Lagisetty: investigation, resources, writing—review and editing.

• Elliot Wakeam: investigation, resources, writing—review and editing.

• Rishindra M. Reddy: conceptualization, methodology, investigation, supervision, writing—review and editing.

• All authors gave final approval of the submitted manuscript to be published.

Corresponding author

Correspondence to Rishindra M. Reddy.

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The authors declare no competing interests.

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Presentation: DDW meeting 2022, San Diego, May 21st, SSAT Oral Quick Shot.

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Ishikawa, Y., Chang, A.C., Lin, J. et al. Wider Gastric Conduit Morphology Is Associated with Improved Blood Flow During Esophagectomy. J Gastrointest Surg 27, 845–854 (2023). https://doi.org/10.1007/s11605-022-05530-7

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