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Association Between Quantitative Blood Flow Measurement Using SPY-QP Software and Prevention of Anastomotic Leakage
Hayato Watanabe1, Sho Sato2, Hiroki Kondo1
1Department of Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Background:
Anastomotic leakage is a severe complication of curative surgery for esophageal cancer, mostly because blood supply to the gastric tube is poor. Although qualitative indocyanine green (ICG) fluorescence imaging has been used to assess blood flow, the subjective nature of this approach poses a challenge. Recently, use of the SPY-PHI system with the SPY-QP software has allowed objective, semiquantitative fluorescence evaluation; however, its utility remains unclear. We investigated the utility of intraoperative SPY-QP-based quantitative perfusion fluorescence imaging for assessing blood flow in the gastric tube and optimizing the anastomotic site to prevent anastomotic leakage in esophageal cancer surgery.
Methods:
This retrospective, single-center study (January 2017 to December 2024) compared two groups of patients who underwent subtotal esophagectomy: the conventional group with qualitative fluorescence assessment (n = 72) and the quantitative group with SPY-QP fluorescence assessment (n = 55). We collected and compared preoperative, intraoperative, and postoperative data, including complications (Clavien-Dindo grade ≥ II) and anastomotic leakage.
Results:
The quantitative group had a significantly higher proportion of patients who underwent preoperative chemotherapy (p < 0.001), retrosternal reconstruction (p = 0.046) and, Gambee/single-layer anastomoses (p < 0.001), and had significantly less intraoperative blood loss (p < 0.001). This group also showed a significantly lower incidence of overall postoperative complications and anastomotic leakage, along with a shorter postoperative hospital stay (p < 0.001). In multivariate analysis, quantitative SPY-QP fluorescence was identified as a favorable independent factor for reducing anastomotic leakage (p = 0.009).
Conclusions:
Quantitative blood flow measurement using SPY-QP may contribute to a reduction in the incidence of anastomotic leakage following esophageal cancer surgery by facilitating the objective selection of the optimal anastomotic site.
