Decreased conduit perfusion measured by spectroscopy is associated with anastomotic complications

Thai H. Pham, Kyle A. Perry, Charles Enestvedt, Dan Gareau, James Dolan, Brett Sheppard, Steven Jacques, John Hunter

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)380-385
Number of pages6
JournalAnnals of Thoracic Surgery
Volume91
Issue number2
DOIs
StatePublished - Feb 2011

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Spectrum Analysis
Stomach
Perfusion
Optical Fibers
Esophagectomy
Blood Volume
Ischemia
Reading
Oxygen
Technology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Decreased conduit perfusion measured by spectroscopy is associated with anastomotic complications. / Pham, Thai H.; Perry, Kyle A.; Enestvedt, Charles; Gareau, Dan; Dolan, James; Sheppard, Brett; Jacques, Steven; Hunter, John.

In: Annals of Thoracic Surgery, Vol. 91, No. 2, 02.2011, p. 380-385.

Research output: Contribution to journalArticle

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abstract = "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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AU - Pham, Thai H.

AU - Perry, Kyle A.

AU - Enestvedt, Charles

AU - Gareau, Dan

AU - Dolan, James

AU - Sheppard, Brett

AU - Jacques, Steven

AU - Hunter, John

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N2 - 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.

AB - 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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