84 | wetenschapsdag 2023 Sessie 3a: Holl(t)en of Stilstaan x1 Auteurs D.C. van der Aa, S.P.G. Henckens, D.J. Nijssen, W.J. Eshuis, S.S. Gisbertz, M.I. van Berge Henegouwen Abstract titel Preventing chyle leakage following minimally invasive esophagectomy: efficacy and feasibility of Indocyanine green fluorescence lymphography Background For oncological reasons, the thoracic duct is resected in esophagectomy, as its complex structure and sensitivity make it prone to damage. Often, its smaller branches and collaterals are hard to see, render it prone to injury. Chyle leakage, a tough post-op problem (incidence of 14-21% ), results in prolonged thoracic drainage, more hospital admission time, additional reinterventions, dietary restrictions, and reduced long-term survival. Indocyanine green (ICG) fluorescence lymphography offers a solution by visualizing the thoracic duct and collaterals accurately, it could lower chyle leakage occurrence and enable immediate treatment upon detection. Methods A prospective observational cohort study will be performed. Patients aged over 18 years with resectable (cT1-4a, N0-3, M0) esophageal carcinoma undergoing a minimally invasive esophagectomy will be included. The primary endpoint of the study is postoperative chyle leakage. Secondary endpoints are overall morbidity and mortality, nature of dietary restrictions, reinterventions, hospital costs, 2 year survival rate and quality of life. Twenty-five milligram of ICG is dissolved in 10 ml of sterile water, obtaining a solution of 2.5 mg ICG per mL. In the McKeown esophagectomy, before the thoracic phase, the surgeon administers a bilateral bolus of 2 mL ultrasound-guided into inguinal lymph nodes. In an Ivor Lewis esophagectomy, 2mL of reconstituted ICG will be injected into the small bowel mesenteric root just under the peritoneum of the mesentery, at the level where the jejunostomy is placed. Results We aim to include 50 patients to assess the feasibility of fluorescent lymphography using ICG to prevent chyle leakage after minimally esophagectomy. Inclusion is ongoing. At this time 49 of 50 patients are included. Results will be expected before the congress
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