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Efficacy of intraoperative ICG fluorescence imaging evaluation for preventing anastomotic leakage after left-sided colon or rectal cancer surgery: a propensity score-matched analysis

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Abstract

Background

Intestinal perfusion at the anastomotic site is thought to be one of the most influential risk factors for postoperative anastomotic leakage (AL). We evaluated the efficacy of indocyanine green (ICG) fluorescence imaging at the stump of the proximal colon in left-sided colectomy or rectal resection in terms of decreasing the incidence of AL.

Methods

Prospectively collected data were retrospectively evaluated. Patients who underwent left-sided colectomy or rectal resection were enrolled (ICG group; n = 197), and patients who had undergone a similar procedure before the ICG group were enrolled from the charts as historical controls (HC group; n = 187). After ICG evaluation, anastomosis was performed where fluorescence was sufficient. The incidence of AL was compared between the ICG and HC groups. Propensity score (PS)-matched data were analyzed to clarify the risk of AL.

Results

AL occurred in 6 patients (3.3%) in the ICG group and 17 (10.7%) in the HC group. ICG evaluation revealed 179 patients with good fluorescence and 18 with poor/none perfusion (9.1%). The transection line was changed in all patients with poor/none fluorescence. Three of these 18 patients developed AL (16.7%), though transection line was changed at which is thought to be good. We hope AL in poor/none fluorescence can be prevented at the same rate of cases with good fluorescence. Actually, the rate of that was significantly higher compared with good fluorescence patients (P = 0.038). 93 patients in each group were compared by PS-matched data analysis, which showed the AL rate in the ICG group was significantly lower than that in the HC group (3.2% vs 10.8%, respectively; P = 0.046).

Conclusions

Even though this study has limitations of comparison of data prospectively collected and retrospectively analyzed, intraoperative ICG fluorescence imaging evaluation could significantly decrease the incidence of AL.

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Acknowledgements

This research was supported by the surgical team in our hospital. We thank our colleagues who provided insight and expertise that greatly assisted the research. We would like to thank Ms. Nobuko Yamada, a secretary in our surgical department, who greatly assisted in the registration of this research, and appreciate voluntary help of Dr. Tamaki Layman and Dr. Ronald Layman.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan

    Takeshi Yanagita, Masayasu Hara, Nozomu Nakai, Yuzo Maeda, Kazuyoshi Shiga, Takahisa Hirokawa, Yoichi Matsuo, Hiroki Takahashi & Shuji Takiguchi

  2. Clinical Research Management Center, Nagoya City University Hospital, Nagoya, Japan

    Satoshi Osaga

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  1. Takeshi Yanagita
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Correspondence to Masayasu Hara.

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Drs. Takeshi Yanagita, Masayasu Hara, Satoshi Osaga, Nozomu Nakai, Yuzo Maeda, Kazuyoshi Shiga, Takahisa Hirokawa, Yoichi Matsuo, Hiroki Takahashi, and Shuji Takiguchi have no conflicts of interest or financial ties to disclose.

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Yanagita, T., Hara, M., Osaga, S. et al. Efficacy of intraoperative ICG fluorescence imaging evaluation for preventing anastomotic leakage after left-sided colon or rectal cancer surgery: a propensity score-matched analysis. Surg Endosc 35, 2373–2385 (2021). https://doi.org/10.1007/s00464-020-08230-y

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