1252 Update on the role of intraoperative indocyanine green fluorescence angiography in preventing anastomotic leakage after colorectal resection in cytoreductive surgery for advanced ovarian cancer

Introduction/Background During the ESGO2022 conference our group presented findings on the impact of indocyanine green fluorescence angiography(ICG-FA) use on the anastomotic leakage rate after colorectal resection during cytoreductive surgery for advanced ovarian cancer(AOC). The objective of the current study is to provide an update of those results. Methodology Patients with AOC undergoing either primary or interval cytoreductive surgery with colorectal resection at the European Institute of Oncology, Milan during 1/2009–12/2012 and 01/2016–12/2022 were identified. The implementation of ICG-FA to assess anastomotic perfusion began at our institution on 1/2020. The rate of anastomotic leak after colorectal resection was compared between the group using ICG-FA and the group not using ICG-FA. The association between the use of ICG-FA and the occurrence of anastomotic leakage was evaluated with univariate and multivariate analysis. Results In total, 544 patients meeting inclusion criteria were identified, including 158(29%) in which ICG-FA was used and 386(71%) in which ICG-FA was not used. Overall, 37(6.8%) patients had a colorectal anastomotic leak, including 3/158(1.9%) in the group using ICG-FA and 34/386(8.8%) in the group not using ICG-FA (p=0.004). On univariate analysis, the presence of residual tumor (p=0.002), preoperative albumin level(p=0.02) and concurrent small bowel resection(0.01) were predictors of colorectal anastomotic leakage, while the use of ICG-FA was a protective factor(p=0.008). On multivariate analysis, concurrent small bowel resection(OR=2.57 CI=1.11–5.97, p=0.03) and residual tumor (OR= 3.33 CI=1.54–7.19, p=0.002) were independent predictors of colorectal anastomotic leakage, while the use of ICG-FA showed an independent protective role(OR=0.29 CI=0.08–0.99, p=0.05). Conclusion These results confirm the role of ICG-FA for the assessment of colorectal anastomosis perfusion in reducing in the rate of colorectal anastomotic leakage. The technique is demonstrated to be both safe and effective. Based on our results, we suggest incorporating the use of ICG-FA for the assessment of all colorectal anastomosis performed during cytoreductive surgery for AOC. Disclosures None.