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Intraoperative fluorescence angiography and risk factors of anastomotic leakage in mini-invasive low rectal resections

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Abstract

Background

One of the prerequisites for proper healing of the anastomosis after a colorectal resection is adequate blood supply to the connected intestinal segments. It has been proposed that adequate visualization of the blood flow using indocyanine green (ICG) could lead to the reduction in the incidence of anastomotic leakage (AL). The aim of this study was to assess the effectiveness of intraoperative fluorescence angiography (FA) in decreasing the incidence of AL after minimally invasive low anterior resection (LAR) with total mesorectal excision (TME) in rectal cancer patients and to determine predictors of anastomotic leak.

Methods

From August 2015 to January 2019, data from 100 patients who underwent mini-invasive TME for rectal cancer using FA with indocyanine green (ICG) were prospectively collected and analyzed. They were compared with retrospectively analyzed data from a historical control group operated by one team of surgeons before the introduction of FA from November 2012 to August 2015 (100 patients). All patients from both groups were operated sequentially in one oncological center in Nový Jičín.

Results

The incidence of AL was significantly lower in the ICG group (19% vs. 9%, p = 0.042, χ2 test). In fifteen patients in the ICG group (15%), the resection line was moved due to insufficient perfusion. Using Pearson’s χ2 test, diabetes (p = 0.036) and application of a transanal drain (NoCoil) (p = 0.032) were identified as other risk factors (RFs) for AL.

Conclusion

The use of ICG to visualize tissue perfusion in low rectal resections for cancer can lead to a reduction of AL.

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Authors and Affiliations

  1. Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic

    Vladimír Benčurik, Matej Škrovina, Lubomír Martínek, Jiří Bartoš, Mária Macháčková, Michal Dosoudil & Erika Štěpánová

  2. Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

    Matej Škrovina & Katherine Vomáčková

  3. Department of Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic

    Lubomír Martínek

  4. Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB – Technical University of Ostrava, Ostrava, Czech Republic

    Lenka Přibylová & Radim Briš

  5. AGEL Research and Training Institute, Prostejov, Czech Republic

    Vladimír Benčurik & Matej Škrovina

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  1. Vladimír Benčurik
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Correspondence to Vladimír Benčurik.

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Vladimír Benčurik, Matej Škrovina, Lubomír Martínek, Jiří Bartoš, Mária Macháčková, Michal Dosoudil, Erika Štěpánová, Lenka Přibylová, Radim Briš, Katherine Vomáčková, have no conflicts of interest or financial ties to disclose.

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Benčurik, V., Škrovina, M., Martínek, L. et al. Intraoperative fluorescence angiography and risk factors of anastomotic leakage in mini-invasive low rectal resections. Surg Endosc 35, 5015–5023 (2021). https://doi.org/10.1007/s00464-020-07982-x

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