[Indocyanine green in delayed esophageal reconstruction after previous extirpation]. / Primenenie indotsianina zelenogo pri otsrochennoi plastike pishchevoda tolstoi kishkoi posle ego ekstirpatsii.

Advanced chemo- and radiotherapy makes it possible to expand the cohort of patients who can undergo surgical treatment for esophageal cancer. Optimization of perioperative approach, diagnosis and modern options for complications reduced early postoperative mortality after esophagectomy. Conduit ischemia with failure of esophageal-gastric or esophageal-intestinal anastomosis is one of the most serious complications. To minimize the risk of anastomotic leakage and graft necrosis in these patients, various methods of intraoperative assessment of graft viability are being investigated. Near-infrared fluorescence imaging with indocyanine green is valuable for real time assessment of graft perfusion. To date, fluorescence imaging is analyzed regarding perfusion of the gastric stalk after esophagectomy. However, there are still few or no data on this method for analysis of colonic conduit perfusion. The absence of plastic material for gastrointestinal reconstruction is the most dangerous moment in case of ischemia and necrosis of colonic graft. We present our first case of delayed retrosternal esophageal repair using intraoperative indocyanine green fluorescence imaging for assessment of conduit perfusion.

[Delayed coloesophagoplasty in difficult clinical situations].

AIM: To improve immediate and long-term results of delayed coloesophagoplasty in cancer patients. MATERIAL AND METHODS: We presented three case reports of coloesophagoplasty in difficult clinical situations including technical impossibility of primary plasty, extraordinary anesthetic situation, transplant necrosis after primary plasty. RESULTS: Gastrointestinal tract integrity was restored in all cases and patients returned to nutrition per os, that provided good quality of life and compensated nutritional deficiencies. Only one patient had bleeding in postoperative period that required relaparotomy. There were no postoperative complications in two other patients. CONCLUSION: Delayed coloesophagoplasty should be performed in all patients who underwent esophagogastrectomy if progression of primary disease is absent. Graft placement and colic segment are chosen individually. However left half of colon with retrosternal location of transplant is preferable for plasty.

[Prognostic factors for the definition of the extent of lymphadenectomy by the early gastric cancer].

The predictive role of submucosal invasion and metastatic spread to local lymph nodes at early gastric cancer was analyzed. Material from 32 patients was morphologically and immunohistochemically analyzed. The prognostic value of the depth of invasion, tenascin and positive MMP2 and MMP9 staining, proliferative activity and microvascular solidity in the lesion were studied. Watch lymph nodes were detected in 22 patients with the diagnosed early gastric cancer. The method is appropriate only by early cancer and in combination with other macro- and microscopic factors. Its' efficacy was 100% in the group of the early cancer (n=15), whereas in the group with the locally spread cancer the sensitivity, accuracy and specificity were 76, 71 and 100%, respectively. Though larger series are necessary to make definite conclusions about the predictive value of watch nodes in gastric cancer.