Objective Grading of MTS With LSCI and Thermography

Study Overview
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Brief Summary
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Mesenteric traction syndrome (MTS) is defined as hypotension, tachycardia and facial flushing in the first hour of surgery, caused by mesenteric traction/abdominal exploration. MTS occurs frequently during abdominal surgery, with incidence around 80 % during open surgery, and lower during minimally invasive surgery. MTS can be divided into different severities using the degree of facial flushing, with the most severe level of MTS being associated with increased postoperative morbidity. Today MTS is diagnosed and graded subjectively by the surgical team, with marked difficulty and limitations. Therefore the investigators developed a cut-off value using the Laser Speckle Contrast Imaging (LSCI), which the investigators wish to confirm in a new cohort, while also examining whether LSCI is interchangeable with digital thermography, which is simpler and cheaper to perfom. The investigators will measure facial perfusion during the first hour of surgery and take blood samples at predefined timepoints to use for biochemical verification of the different severities of MTS. Three cohorts will be included 45 open esophagectomies or gastrectomies 50 whipple surgery 35 robot assisted esophagectomies or gastrectomies These patients will be use in multiple articles examining different aspects of MTS One study examining LSCI and thermography for the identification and grading of MTS will use 60 patients undergoing open esophagectomy or gastrectomy or whipple surgery, in this study patients will not be excluded if they are found to be disseminated.

Official Title
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Is Objective Grading of Mesenteric Traction Syndrome With Laser Speckle Contrast Imaging Interchangeable With Digital Thermography

Conditions
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Mesenteric Traction Syndrome

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Undergoing curative surgery for esopageal, gastric, doudenal or pancreatic cancer Exclusion Criteria: Known flushing disease Patients recieving NSAID and corticosteroid presurgery, Whipple is allowed to recieve single dose of 125 mg Methylprednisone as part of the standard of care at our facility. Palliative surgery Surgery not completed due to disseminated disease - patients will still be used in examination of LSCI and Thermography analysis even if desiminated

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severity of MTS - measured facial perfusion | Facial perfusion measured with LSCI and Digital Thermography | first hour of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Biochemical markers of MTS - prostacyclin |  | During surgery | 
| Hemodynamics |  | During surgery | 
| Markers of postoperative impact of MTS - IL6 and endothelial damage markers |  | During and after surgery | 
| 30-day postoperative morbidity |  | 30 days post surgery | 
| Incidence of objective MTS during whipples procedure with methylprednisolone prophylaxis |  | During surgery | 
| Incidence of objective MTS during minimally invasive surgery |  | during surgery | 
| PACU - fluid therapy administred at PACU |  | At the PostAnesthesia Care Unit following surgery. Typically one to two days | 
| PACU - vasopressor requirements |  | At the PostAnesthesia Care Unit following surgery.Typically one to two days | 
| PACU - length of stay |  | At the PostAnesthesia Care Unit following surgery. Typically one to two days | 
| suPAR (soluble urokinase Plasminogen Activator Receptor). |  | baseline just prior to surgery |