Sixty-two patients underwent esophagectomy for thoracic esophageal cancer, three were treated for cervical esophageal cancer, and five had double cancer in the thoracic and cervical regions (Table 18.1). There were 56 men and 14 women with an average age of 67 years (range, 44–86 years). Twenty-one patients received preoperative chemotherapy, two received preoperative chemoradiotherapy, and two had received radiotherapy several years before surgery. Three patients who had undergone jejunal graft reconstruction and two patients who had undergone esophageal bypass were evaluated at this time. Two patients who underwent partial resection for gastric tube cancer in the reconstructed gastric tube were also evaluated (Table 18.2).

After esophagectomy, we made a gastric tube or colonic graft and pulled it up via the retrosternal, posterior mediastinal, or subcutaneous route depending on the patient. We routinely used the retrosternal route. A gastric tube was commonly fashioned with a width of 4 cm. Anastomosis was performed in the cervical region by hand sewing or using a circular stapler (25-mm EEA) [9]. We used a subcutaneous route for esophageal bypass. When a free jejunal graft was used, we first made a hand-sewn pharyngo-jejuno anastomosis, followed by microvascular anastomosis, and then jejuno-esophago anastomosis.

After preparing the gastric tube, the end of the short gastric vein was cut and we assessed the status of bleeding. Additional venous drainage was considered if bleeding was not continuous or very weak. We performed ICG fluorescence of the gastric tube in order to determine whether additional drainage was likely to be effective. If ICG fluorescence revealed a strong microvascular network, we concluded that the gastric tube did not need additional venous drainage or arterial anastomosis. If ICG fluorescence first appeared or became stronger after cutting the short gastric vein, we concluded that additional venous drainage would be effective. If ICG fluorescence did not appear after cutting the short gastric vein, additional arterial anastomosis was performed. If additional drainage or anastomosis was needed, anastomosis was performed between the short gastric vein or artery and the external cervical or superficial cervical vein [8].

Before and after pulling up the reconstructed organ, 2.5 mg of ICG dye (Diagnogreen; Dai-Ichi Pharm, Tokyo, Japan) was injected as a bolus. ICG fluorescence imaging was then performed using a near-infrared camera system (Photodynamic Eye; Hamamatsu Photonics K.K., Hamamatsu, Japan) and images were recorded. Briefly, images were obtained with a charge-coupled device (CCD) camera using a light-emitting diode with a wavelength of 760 nm as the light source and a filter to eliminate light with wavelengths below 820 nm before detection [10]. Images were sent to a digital video processor and displayed on a monitor. [8]. In the case of gastric tube cancer, ICG fluorescence was performed before and after partial resection of the gastric tube.