Evaluation of Remnant Esophageal Perfusion Using Indocyanine Green Fluorescence Imaging during Ivor Lewis Esophagectomy after Total Pharyngolaryngectomy: A Case Report

INTRODUCTION: Head and neck cancer frequently coexists with synchronous or metachronous esophageal cancer, owing to shared carcinogenic exposures such as alcohol and tobacco use. In patients undergoing esophagectomy after total pharyngolaryngectomy (TPL), surgical reconstruction poses significant challenges due to dense adhesions and altered cervical anatomy. The McKeown procedure requires cervical manipulation, demanding careful preservation of the tracheal stoma and free jejunal graft blood supply. In contrast, the Ivor Lewis procedure eliminates the need for cervical maneuver but necessitates an intrathoracic anastomosis between the gastric conduit and the remnant esophagus. This raises concerns regarding potential ischemia of the remnant esophagus, particularly after prior TPL, in which proximal blood supply may be compromised. We report a case of successful robot-assisted Ivor Lewis esophagectomy after TPL, in which intraoperative indocyanine green (ICG) fluorescence imaging was used to confirm sufficient blood supply in the remnant esophagus and to ensure a safe anastomosis.