A prospective trial of intraoperative tissue oxygenation measurement and its association with anastomotic leak rate after Ivor Lewis esophagectomy Journal Article


Authors: Adusumilli, P. S.; Bikson, M.; Rizk, N. P.; Rusch, V. W.; Hristov, B.; Grosser, R.; Tan, K. S.; Sarkaria, I. S.; Huang, J.; Molena, D.; Jones, D. R.; Bains, M. S.
Article Title: A prospective trial of intraoperative tissue oxygenation measurement and its association with anastomotic leak rate after Ivor Lewis esophagectomy
Abstract: Background: Anastomotic leak following Ivor Lewis esophagectomy is associated with increased morbidity/mortality and decreased survival. Tissue oxygenation at the anastomotic site may influence anastomotic leak. Methods for establishing tissue oxygenation at the anastomotic site are lacking. Methods: Over a 2-year study period, 185 Ivor Lewis esophagectomies were performed. Study participants underwent measurement of gastric conduit tissue oxygenation at the planned anastomotic site using the wireless pulse oximetry device. Associations between anastomotic leaks or strictures and tissue oxygenation levels were analyzed using Wilcoxon rank sum test or Fisher's exact test. Results: Among study participants (n=114), median gastric conduit tissue oxygenation level was 92% (range, 62-100%). There were 8 (7.0%) anastomotic leaks and 3 (2.6%) strictures. Analysis of tissue oxygenation as a continuous variable showed no difference in median tissue oxygenation in patients with and without leaks (98% and 92%; P=0.2) and stricture formation (89% and 92%; P=0.6). Analysis of tissue oxygenation as a dichotomous variable found no difference in anastomotic leak rates [7.5% (n=93) in >80% vs. 0% (n=20) in ≤80%; P=0.3]. There were no significant differences in leak rates in concurrent study nonparticipants. Conclusions: No significant association was observed between intraoperative tissue oxygenation at the anastomotic site and subsequent anastomotic leak or stricture formation among patients undergoing Ivor Lewis esophagectomy. © 2020 Journal of Thoracic Disease.
Keywords: controlled study; aged; major clinical study; review; preoperative evaluation; prospective study; smoking; comorbidity; esophagus resection; esophagus cancer; oxygen saturation; chemoradiotherapy; esophageal cancer; induction chemotherapy; tissue oxygenation; anastomosis leakage; tissue perfusion; ivor lewis esophagectomy; anastomotic leak; pulse oximetry; preoperative chemotherapy; artery perfusion; human; male; female
Journal Title: Journal of Thoracic Disease
Volume: 12
Issue: 4
ISSN: 2072-1439
Publisher: Pioneer Bioscience Publishing Company  
Date Published: 2020-04-01
Start Page: 1449
End Page: 1459
Language: English
DOI: 10.21037/jtd.2020.02.58
PROVIDER: scopus
PMCID: PMC7212129
PUBMED: 32395282
DOI/URL:
Notes: Review -- Export Date: 1 July 2020 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Valerie W Rusch
    825 Rusch
  2. Nabil Rizk
    139 Rizk
  3. James Huang
    185 Huang
  4. Manjit S Bains
    326 Bains
  5. David Randolph Jones
    364 Jones
  6. Daniela   Molena
    223 Molena
  7. Kay See   Tan
    210 Tan