467. USEFUL ANASTOMOSIS AFTER ESOPHAGECTOMY USING ICG FLOW AND COLLARD MODIFIED METHOD

Risk of anastomotic leakage after esophagectomy is reported comorbidity, surgical technique, and others. One of management to reduce AL is to measure indocyanine green (ICG) of gastric conduit. It may be more sensitive and useful than traditional method. Furthermore, by changing the anastomotic technique with modified Collard method, AL rate was reduced from 15% to 4% and anastomotic stenosis was also reduced. In this study, we examined some marker of stomach roll depiction by ICG. We enrolled 52 cases for which ICG data were obtained from August 2019 to December 2021. The distance from stump of the stomach roll was measured by marking the line ICG 5mg stained after 30, 60 seconds We examined some data of arterial network between left and right gastroepiploic arteries, the depiction of gastric conduit, and intra andextramural vessels from the wall from the recorded images. We decided anastomotic line stained with ICG in 30 second. We reconstructed gastric conduit with 42 stomach roll and 10 subtotal stomach. The distance of gastric conduit stained with ICG was Mean ± SD: 47 ± 19 mm (0-80 mm) at 30 seconds and 28 ± 17 mm (0-60 mm) at 60 seconds. Arterial network between left and right gastroepiploic artery: yes/no (8:43), whole gastric wall depiction: yes/no (24/28), extramural blood flow: yes/no (44/7). There was no necrosis of gastric conduit, AL rate was 3.8% (2/52), and anastomotic stenosis requiring endoscopic bougie was 2%. Ten cases of subtotal stomach had no AL and stenosis. By using ICG, anastomotic line drawn in 30 second was shorter than 60 seconds and gastric conduit was shorter than traditional line. Determining good blood flow sites using ICG in gastric conduit and widening anastomotic caliber using modified Collard method may have reduced AL and stenosis. It is considered to be very simple procedure that does not depend on surgeon.