Indocyanine green fluorescent imaging (ICG-FI) in esophagectomy: single-center experience

<b>Introduction:</b> Gold standard treatment for locally advanced esophageal cancer is subtotal resection of the esophagus with resection of regional lymph nodes. Despite being performed in experienced and specialized centers, this procedure is associated with a high rate of complications. Complications such as anastomotic fistula and leakage can be life-threatening, primarily resulting from inadequate blood circulation in the anastomosis area. <br><br><b>Aim:</b> The aim of the study is to present the results of intraoperative indocyanine green (ICG) application in order to verify the adequate perfusion in esophagogastric anastomosis. <br><br><b>Materials and methods:</b> This is a single-center prospective analysis of 32 patients who underwent subtotal esophagectomy with regional lymph node resection for esophageal carcinoma. In all cases, intraoperative perfusion assessment using ICG fluorescence imaging (ICG-FI) was performed. Patient characteristics, comorbidities, and postoperative outcomes were analyzed, with treatment effects monitored for up to 1 year postoperatively. <br><br><b>Results:</b> Six patients required gastric conduit reduction due to poor blood perfusion visualized by intraoperative ICG-FI. Anastomotic leakage occurred in two cases, which were managed endoscopically with endo-vac therapy and esophageal stent placement. The remaining patients did not require additional surgical interventions during the postoperative course. <br><br><b>Conclusions:</b> The use of ICG dye in esophageal surgery appears to be a beneficial tool for objective assessment of perfusion that may be a valuable prediction factor in the postoperative course.