07 July 2012

Decreased conduit perfusion measured by spectroscopy is associated with anastomotic complications

Posted in Publications, Scientific Publications

Pham TH, Perry KA, Enestvedt CK, Gareau D, Dolan JP, Sheppard BC, Jacques SL, Hunter JG

Background. Gastric conduit ischemia during esophagectomy

likely contributes to high anastomotic complication

rates, yet we lack a reliable method to assess gastric

conduit perfusion. We hypothesize that optical fiber spectroscopy

(OFS) can reliably assess conduit perfusion and

that the degree of intraoperative gastric ischemia is associated

with subsequent anastomotic complications.

Methods. During esophagectomy, OFS was used to

measure oxygen saturation (SaO2) and blood volume

fraction (BVF) in the distal gastric conduit at baseline

and after gastric devascularization, conduit formation,

and transposition. The SaO2 and BVF readings were

correlated to clinical outcomes.

Results. The OFS measurements were obtained in 23

patients during esophagectomy, four of whom previously

underwent gastric ischemic conditioning. Eight

patients developed anastomotic complications. Compared

with baseline, conduit creation produced a 29.4%

reduction in SaO2 (p < 0.01), while BVF increased by 28%

(p  0.06). Patients with subsequent anastomotic complications

demonstrated a 52.5% decrease in SaO2 upon

conduit creation compared with 15.1% in patients without

complications (p  0.01). Patients who underwent

ischemic conditioning did not develop significant

changes in SaO2 (p  0.72) or BVF (p  0.5) upon gastric

conduit creation.

Conclusions. Intraoperative OFS demonstrates significant

alterations in gastric conduit oxygenation during

esophageal replacement, which may be tempered by

gastric ischemic conditioning. The degree of intraoperative

gastric ischemia resulting from gastric conduit creation

is associated with the development of anastomotic

complications, suggesting that OFS is useful for assessing

changes in conduit oxygenation during esophagectomy.

Further studies are needed to refine this technology

and investigate the clinical utility of intraoperative conduit

oxygenation data.

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