• Katsunori Nishikawa, Tetsuji Fujita, Masami Yuda, Yujiro Tanaka, Akira Matsumoto, Yuichiro Tanishima, Nobuyoshi Hanyu, and Katsuhiko Yanaga.
• Department of Surgery, The Jikei University, Tokyo, Japan.
• Ann. Surg. 2020 Jun 1; 271 (6): 1087-1094.

ObjectiveThe study's primary aim was to evaluate the effectiveness of thermal imaging (TI) and its secondary aim was to compare TI and indocyanine green (ICG) fluorescence angiography, with respect to the evaluation of the viability of the gastric conduit.Summary Background DataThe optimal method for evaluating perfusion in the gastric conduit for esophageal reconstruction has not been established.MethodsWe reviewed the prospectively collected data of 263 patients who had undergone esophagectomy with gastric conduit reconstruction. TI was used in all patients. ICG fluorescence was concomitantly used in 24 patients to aid comparison with TI. A cut-off value of the anastomotic viability index (AVI) was calculated using the receiver operating characteristic curve in TI.ResultsAnastomotic leak was significantly less common in patients with AVI > 0.61 compared with those with AVI ≤ 0.61 (2% vs 28%, P< 0.001). Microvascular augmentation was performed in 20 patients with a low AVI score and/or preoperative chemoradiotherapy. Overall ability was comparable between TI and ICG fluorescence regarding the qualitative evaluation of the gastric conduit. However, TI was superior in the quantitative assessment of viability.ConclusionsTI could delineate the area of good perfusion in the gastric conduit for esophageal reconstruction, which can help identify patients at high risk of anastomotic leak.

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