Real-time assessment of graft oxygenation and perfusion using spectral imaging for improved outcome in esophageal cancer surgery

Esophageal cancer surgery is challenged by anastomotic leakage (AL), affecting 8-20% of patients and leading to a prolonged hospital stay, severe morbidity or even death. Tissue hypoxia at the surgical connection site is a primary cause of AL, highlighting the critical need for reliable intraoperative hypoxia monitoring. This study presents initial findings from a clinical evaluation of real-time multispectral imaging (MSI) as a non-invasive tool for use during laparoscopic esophagectomy in humans. MSI of the stomach graft was conducted at video rate using a snapshot camera operating in the 460 - 600 nm spectral range. Tissue oxygenation was visualized and compared to indocyanine green fluorescence imaging (ICG-FI) and capillary lactate measurements. Preliminary results revealed critically low oxygenation levels (8.10 ± 5.99%) at the anastomotic site in a patient with AL, compared to higher levels (60.65 ± 12.83%) in a patient without AL. Furthermore, MSI and ICG-FI are found complementary, but discrepancies arise when assessing the ideal anastomotic site. These findings highlight MSI’s potential as a non-invasive and real-time intraoperative method of tissue hypoxia assessment, possibly reducing AL rates and improving surgical outcomes.