Key result
Intraoperative indocyanine green fluorescence imaging was associated with a lower overall anastomotic leakage rate compared to no imaging (9.3% vs 16.0%, p=0.058) after propensity score matching.
Why the study?
Anastomotic leakage is a major complication of colorectal cancer surgery, prompting evaluation of intraoperative indocyanine green fluorescence imaging for its prevention during laparoscopic colorectal surgery.
Does intraoperative indocyanine green fluorescence imaging reduce anastomotic leakage in patients undergoing laparoscopic colorectal surgery?
Cohort (n=272)
No
Does intraoperative indocyanine green fluorescence imaging reduce anastomotic leakage in patients undergoing laparoscopic colorectal surgery?
Odds Ratio: 0.66 (95% CI 0.3–1.46)
Absolute Event Rate: 9.3% vs 16%
p-value: p=0.058
Intraoperative ICG fluorescence imaging may reduce the incidence of overall anastomotic leakage and clinically significant fistulas in laparoscopic colorectal surgery.
Nonsignificant AL reduction with ICG after matching; leaves open benefit in colorectal surgery pending RCTs.
Anastomotic leakage (AL) represents one of the most relevant complications of colorectal cancer surgery. The aim of this study was to evaluate the utility of intraoperative indocyanine green (ICG) fluorescence imaging in the prevention of AL during laparoscopic colorectal surgery. Methods. We retrospectively analyzed 272 patients who underwent rectal and left colon surgery, consecutively enrolled between 2015 and 2019. Due to the heterogeneity of our groups, a propensity score matching (PSM) was performed with a 1:1 PSM cohort. Results. AL occurred in 36 (13.2%) patients. One hundred seventy-seven (65%) of them underwent an intraoperatory ICG test (ICG-group), whereas 95 patients (35%) did not receive the intraoperatory ICG test (no-ICG group). AL occurred in 10.8% of ICG group patients and in 17.8% of no-ICG group patients ( P = 0.07). The ICG group registered significantly less type B and type C fistulas than the no-ICG group (57.9 vs 88.2%; P = .043). After PSM, the overall AL rate was less in the ICG group than the no-ICG group (9.3% vs 16%; P = 0.058), while type B and type C fistulas occurred in 5.48% in the ICG group vs 13.70% in the no-ICG group ( P = 0.09). Univariate analysis demonstrated a protective effect of intraoperative ICG imaging against AL occurrence (odds ratio (OR: 0.66)). Conclusions. Hypoperfusion is a well-recognized cause of AL. The ICG assessment of colic vascularization is a simple, inexpensive, and side effects free method, which can sensibly reduce both overall AL and type B and type C fistulas when routinely used.
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Losurdo et al. (2020) conducted a cohort in Rectal and left colon cancer (n=272). Intraoperative indocyanine green (ICG) fluorescence imaging vs. No intraoperative ICG test (historical control) was evaluated on Overall anastomotic leakage (AL) rate after propensity score matching (OR 0.66, 95% CI 0.30-1.46, p=0.058). Intraoperative indocyanine green fluorescence imaging was associated with a lower overall anastomotic leakage rate compared to no imaging (9.3% vs 16.0%, p=0.058) after propensity score matching.
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