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The usefulness of indocyanine green fluorescence imaging for intestinal perfusion assessment of intracorporeal anastomosis in laparoscopic colon cancer surgery

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Abstract

Purpose

The purpose of this study was to clarify the usefulness of indocyanine green fluorescence imaging (ICG-FI) in the assessment of intestinal vascular perfusion in patients who receive intracorporeal anastomosis (IA) in colon cancer surgery.

Methods

This was a single-center, retrospective study using propensity score matching. We compared the surgical outcomes of colon cancer patients who underwent laparoscopic colonic resection with IA or external anastomosis (EA) with the intraoperative evaluation of anastomotic perfusion using ICG-FI from January 2019 to July 2021. The detection rate of poor anastomotic perfusion by ICG-FI was examined.

Results

A total of 223 patients were enrolled. After matching, 69 patients each were classified into the IA and EA groups. There were no significant differences in age, sex, body mass index, tumor localization, or progression between the two groups. The operation time was similar (172 min vs. 171 min, p = 0.62) and the amount of bleeding was significantly lower (0 ml vs. 2 ml, p = 0.0023) in the IA group. The complication rates (grade ≥ 2) of the two groups were similar (14.5% vs. 11.6%, p = 0.59). ICG-FI identified four patients (5.8%) with poor anastomotic perfusion in the IA group, but none in the EA group (p = 0.046). All four patients with poor perfusion in the IA group underwent additional resection; none of these patients developed postoperative complications.

Conclusion

Poor anastomotic perfusion was detected in 5.8% of cases who underwent laparoscopic colon cancer surgery with IA. ICG-FI is useful for evaluating anastomotic perfusion in IA in order to prevent AL.

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Data Availability

The collected data or related documents will not be made available to others.

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Acknowledgements

The authors would like to express their heartfelt gratitude to Nanako Sasaki at the Yokohama City University Medical Center who always provided carefully considered, constructive feedback and valuable comments.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan

    Kenta Iguchi, Jun Watanabe, Yusuke Suwa, Keigo Chida, Yosuke Atsumi, Masakatsu Numata, Tsutomu Sato, Kazuhisa Takeda & Chikara Kunisaki

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  1. Kenta Iguchi
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  2. Jun Watanabe
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  3. Yusuke Suwa
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Contributions

Kenta Iguchi, Jun Watanabe, Yusuke Suwa, Keigo Chida, Yosuke Atsumi, Masakatsu Numata, Tsutomu Sato, Kazuhisa Takeda, and Chikara Kunisaki contributed to the conception and design of the study. Kenta Iguchi, Yusuke Suwa, Keigo Chida, Yosuke Atsumi, and Masakatsu Numata prepared data collection. Kenta Iguchi wrote the main manuscript text. All authors reviewed the manuscript and accepted the final version.

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Correspondence to Jun Watanabe.

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Iguchi, K., Watanabe, J., Suwa, Y. et al. The usefulness of indocyanine green fluorescence imaging for intestinal perfusion assessment of intracorporeal anastomosis in laparoscopic colon cancer surgery. Int J Colorectal Dis 38, 7 (2023). https://doi.org/10.1007/s00384-023-04307-x

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