Fluorescence guidance in digestive surgery / 中华消化外科杂志

Near infrared fluorescence capitalizes on the unique features of fluorophores by highlighting critical structures and allowing surgeons to assess vascular perfusion of native tissues. In this review, the authors discuss the physics of fluorescence, characteristics of commonly used fluorophores, and features of approved devices for use in surgery. The authors discuss supporting data and reports of fluorescence guidance in assessment and planning for colorectal and gastroesophageal anastomosis, identification of liver tumors, delineation of biliary anatomy during cholecystectomy, and localization of ureters. Future directions for the use of fluorescence guidance in gastrointestinal surgery include antibody-conjugated fluorophores to detect foci of tumor metastasis.

Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center

PURPOSE: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GC-ERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. MATERIALS AND METHODS: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015–October 1, 2016) with the historical control (HC) group (January 1, 2012–October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. RESULTS: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P < 0.001) and intraabdominal drain placement (25% vs. 85%, P < 0.001), faster advancement of diet (P < 0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). CONCLUSIONS: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.