P1.192. Prospective Observational Study of Intraoperative Right Gastroepiploic Artery Flow and Anastomosis Level (Distance From Upper Incisors) in Ivor-Lewis Esophagectomy

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background Anastomotic leakage after esophagectomy is strongly associated with gastric conduit ischemia. Although indocyanine green fluorescence imaging is widely used, quantitative perfusion assessment remains limited. This study evaluated intraoperative right gastroepiploic artery (RGEA) blood flow using Doppler ultrasound during Ivor Lewis esophagectomy and assessed its relationship with perioperative outcomes. Methods This prospective observational study included 52 patients undergoing Ivor Lewis esophagectomy with gastric conduit reconstruction for esophageal cancer between July 2025 and the present. Intraoperative Doppler ultrasound was performed after completion of the abdominal phase to measure proximal and distal RGEA flow volume, vessel diameter, peak systolic velocity, and end-diastolic velocity. Anastomosis level and anatomical distance between the RGEA and anastomosis site were assessed using postoperative computed tomography and endoscopy. Perioperative outcomes included ICU stay, oral diet initiation, conduit-related complications, and anastomotic leakage. Correlation and regression analyses were performed to evaluate associations between intraoperative perfusion parameters and perioperative outcomes. Results The mean proximal and distal RGEA flow volumes were 24.8±6.4 mL/min and 20.6±7.7 mL/min, respectively. The distal-to-proximal flow ratio was 0.82±0.13, suggesting preserved distal conduit perfusion after conduit creation. The mean anastomosis level corresponded to the T2 vertebral level, with a mean RGEA-to-anastomosis distance of 36.8±4.6 cm. No anastomotic leakage or conduit necrosis occurred during the study period. Distal-to-proximal flow ratio showed a negative trend with ICU stay (r=-0.44, p=0.054), whereas no significant correlations were observed between RGEA flow parameters and oral diet initiation or other short-term recovery indicators. Conclusion Intraoperative Doppler-based RGEA flow assessment during Ivor Lewis esophagectomy is feasible and provides objective quantitative perfusion data for gastric conduit evaluation. Although no significant association was observed between RGEA flow and short-term recovery outcomes, preserved distal perfusion was consistently demonstrated after conduit creation. Quantitative anatomical mapping of the RGEA and anastomosis site may provide a useful foundation for future studies investigating conduit ischemia, anastomotic complications, and perfusion-guided surgical strategies.