Role of indocyanine green fluorescence imaging on blood flow evaluation of the reconstructed conduit after esophageal cancer surgery

Esophagectomy remains a standard curative treatment for localized thoracic esophageal cancer. However, morbidity is a major concern after surgery because of the surgical invasiveness and the complex operative procedures. The anastomosis between the cervical esophagus and the reconstructed conduit is more likely to leak than other gastrointestinal anastomosis and is consequently associated with higher postoperative mortality. Among several factors, such as patient factors, surgical techniques, and tissue factors, that is a high probability that ischemia at the tip of the reconstructed conduit can attribute to the anastomotic leakage. Traditional practice has been to check the pulsation of the marginal artery, the color of the conduit, and/or bleeding from the cutting edge of the bowel. These methods are all subjective and rarely provide a clear demarcation between good blood perfusion area and non-good blood perfusion area of the reconstructed conduit. Instead, to obtain the objective information of blood perfusion of the reconstructed conduit and to decide the appropriate anastomotic site after esophagectomy, laser Doppler flowmetry emerged as a tissue blood flow assessment system. However, it has not been widely accepted by surgeons due to the lack of reproducibility and no apparent correlation