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Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study

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Abstract

Background

Recent studies have shown the potential benefit of indocyanine green fluorescence imaging (ICG-FI) in lowering the anastomotic leakage (AL) rates by changing the surgical plan. The aim of this study was to evaluate the effect of ICG-FI on the AL rates in laparoscopic low anterior resection (LAR) for rectal cancer.

Methods

From September 2014 to December 2017, data from patients who underwent laparoscopic LAR for rectal cancer were collected and analyzed. The primary endpoint was the AL rate within 30 days after surgery. The incidence of AL in patients who underwent ICG (ICG-FI group) was compared with that in patients who did not undergo ICG (non-ICG-FI group) using propensity score matching.

Results

Data from 550 patients were collected from 3 institutions. A total of 211 patients were matched in both groups by the propensity score. ICG-FI shifted the point of the proximal colon transection line toward the oral side in 12 patients (5.7%). The AL rates of Clavien–Dindo (CD) grade ≥ II and ≥ III were 10.4% (22/211) and 9.5% (20/211) in the non-ICG-FI group and 4.7% (10/211) and 2.8% (6/211) in the ICG-FI group, respectively. ICG-FI significantly reduced the AL rate of CD grade ≥ II and ≥ III (odds ratio (OR) 0.427; 95% confidence interval (CI) 0.197–0.926; p = 0.042 and OR 0.280; CI 0.110–0.711; p = 0.007, respectively). The rate of reoperation was significantly lower (OR 0.192; CI 0.042–0.889; p = 0.036) and the postoperative hospital stay significantly shorter (mean difference 2.62 days; CI 0.96–4.28; p = 0.002) in the ICG-FI group than in the non-ICG-FI group.

Conclusions

ICG-FI was associated with significantly lower odds of AL in laparoscopic LAR for rectal cancer.

Clinical trial

The study was registered with the Japanese Clinical Trials Registry as UMIN000032654.

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References

  1. Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237

    Article  Google Scholar 

  2. Group ESoCc (2017) The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Colorectal Dis 19:e296–e311

    Article  Google Scholar 

  3. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102:462–479

    Article  CAS  Google Scholar 

  4. Phitayakorn R, Delaney CP, Reynolds HL, Champagne BJ, Heriot AG, Neary P, Senagore AJ, International Anastomotic Leak Study Group (2008) Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg 32:1147–1156

    Article  CAS  Google Scholar 

  5. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899

    Article  Google Scholar 

  6. Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23:703–707

    Article  Google Scholar 

  7. Cui Y, Chen H (2003) The effect of tension on esophagogastric anastomotic wound healing in rats. J Cardiovasc Surg 44:775–778

    CAS  Google Scholar 

  8. Attard JA, Raval MJ, Martin GR, Kolb J, Afrouzian M, Buie WD, Sigalet DL (2005) The effects of systemic hypoxia on colon anastomotic healing: an animal model. Dis Colon Rectum 48:1460–1470

    Article  Google Scholar 

  9. Shikata J, Shida T (1986) Effects of tension on local blood flow in experimental intestinal anastomoses. J Surg Res 40:105–111

    Article  CAS  Google Scholar 

  10. Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82

    Article  CAS  Google Scholar 

  11. Wilker D, Sklarek J, Waldner H, Izbicki JR, Siebeck M (1988) [Early phase of healing of anastomoses with special reference to peritonitis and ischemia]. Langenbecks Arch Chir 373:217–221

    Article  CAS  Google Scholar 

  12. Kudszus S, Roesel C, Schachtrupp A, Hoer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbeck’s Arch Surg 395:1025–1030

    Article  Google Scholar 

  13. Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM (2009) Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 24:569–576

    Article  CAS  Google Scholar 

  14. Hallbook O, Johansson K, Sjodahl R (1996) Laser Doppler blood flow measurement in rectal resection for carcinoma–comparison between the straight and colonic J pouch reconstruction. Br J Surg 83:389–392

    Article  CAS  Google Scholar 

  15. Seike K, Koda K, Saito N, Oda K, Kosugi C, Shimizu K, Miyazaki M (2007) Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery. Int J Colorectal Dis 22:689–697

    Article  Google Scholar 

  16. Toens C, Krones CJ, Blum U, Fernandez V, Grommes J, Hoelzl F, Stumpf M, Klinge U, Schumpelick V (2006) Validation of IC-VIEW fluorescence videography in a rabbit model of mesenteric ischaemia and reperfusion. Int J Colorectal Dis 21:332–338

    Article  CAS  Google Scholar 

  17. Ris F, Liot E, Buchs NC, Kraus R, Ismael G, Belfontali V, Douissard J, Cunningham C, Lindsey I, Guy R, Jones O, George B, Morel P, Mortensen NJ, Hompes R, Cahill RA, Near-Infrared Anastomotic Perfusion Assessment Network V (2018) Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg 105:1359–1367

    Article  CAS  Google Scholar 

  18. Grone J, Koch D, Kreis ME (2015) Impact of intraoperative microperfusion assessment with Pinpoint Perfusion Imaging on surgical management of laparoscopic low rectal and anorectal anastomoses. Colorectal Dis 17(Suppl 3):22–28

    Article  Google Scholar 

  19. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220:82–92

    Article  Google Scholar 

  20. Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E (2017) Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 31:1836–1840

    Article  Google Scholar 

  21. Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA (2014) The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc 28:1695–1702

    Article  Google Scholar 

  22. Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2013) The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27:3003–3008

    Article  Google Scholar 

  23. Kawada K, Hasegawa S, Wada T, Takahashi R, Hisamori S, Hida K, Sakai Y (2017) Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis. Surg Endosc 31:1061–1069

    Article  Google Scholar 

  24. Wada T, Kawada K, Takahashi R, Yoshitomi M, Hida K, Hasegawa S, Sakai Y (2017) ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc 31:4184–4193

    Article  Google Scholar 

  25. Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22:15–23

    Article  CAS  Google Scholar 

  26. Guraieb-Trueba M, Frering T, Atallah S (2016) Combined endoscopic and laparoscopic real-time intra-operative evaluation of bowel perfusion using fluorescence angiography. Tech Coloproctol 20:883–884

    Article  CAS  Google Scholar 

  27. Shiomi A, Ito M, Maeda K, Kinugasa Y, Ota M, Yamaue H, Shiozawa M, Horie H, Kuriu Y, Saito N (2015) Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg 220:186–194

    Article  Google Scholar 

  28. Austin PC (2011) Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10:150–161

    Article  Google Scholar 

  29. Protyniak B, Dinallo AM, Boyan WP Jr, Dressner RM, Arvanitis ML (2015) Intraoperative indocyanine green fluorescence angiography—an objective evaluation of anastomotic perfusion in colorectal surgery. Am Surg 81:580–584

    PubMed  Google Scholar 

  30. Nishigori N, Koyama F, Nakagawa T, Nakamura S, Ueda T, Inoue T, Kawasaki K, Obara S, Nakamoto T, Fujii H, Nakajima Y (2016) Visualization of lymph/blood flow in laparoscopic colorectal cancer surgery by ICG fluorescence imaging (Lap-IGFI). Ann Surg Oncol 23(Suppl 2):S266–S274

    Article  Google Scholar 

  31. Sherwinter DA, Gallagher J, Donkar T (2013) Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion: a feasibility study. Colorect Dis 15:91–96

    Article  CAS  Google Scholar 

  32. Kim JC, Lee JL, Yoon YS, Alotaibi AM, Kim J (2016) Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients. Int J Med Robot Comput Assist Surg MRCAS 12:710–717

    Article  Google Scholar 

  33. Foppa C, Denoya PI, Tarta C, Bergamaschi R (2014) Indocyanine green fluorescent dye during bowel surgery: are the blood supply “guessing days” over? Tech Coloproctol 18:753–758

    Article  CAS  Google Scholar 

  34. Kim JC, Lee JL, Park SH (2017) Interpretative guidelines and possible indications for indocyanine green fluorescence imaging in robot-assisted sphincter-saving operations. Dis Colon Rectum 60:376–384

    Article  Google Scholar 

  35. Diana M, Agnus V, Halvax P, Liu YY, Dallemagne B, Schlagowski AI, Geny B, Diemunsch P, Lindner V, Marescaux J (2015) Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model. Br J Surg 102:e169–e176

    Article  CAS  Google Scholar 

  36. Diana M, Noll E, Diemunsch P, Dallemagne B, Benahmed MA, Agnus V, Soler L, Barry B, Namer IJ, Demartines N, Charles AL, Geny B, Marescaux J (2014) Enhanced-reality video fluorescence: a real-time assessment of intestinal viability. Ann Surg 259:700–707

    Article  Google Scholar 

  37. Herbert RD (2000) How to estimate treatment effects from reports of clinical trials. II: Dichotomous outcomes. Aust J Physiother 46:309–313

    Article  Google Scholar 

  38. Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M (2011) Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg 15:120–129

    Article  Google Scholar 

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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

    Jun Watanabe, Yusuke Suwa, Mitsuyoshi Ota & Chikara Kunisaki

  2. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Atsushi Ishibe & Itaru Endo

  3. Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan

    Hirokazu Suwa

Authors
  1. Jun Watanabe
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  2. Atsushi Ishibe
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  3. Yusuke Suwa
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  4. Hirokazu Suwa
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Correspondence to Jun Watanabe.

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Jun Watanabe, Atsushi Ishibe, Yusuke Suwa, Hirokazu Suwa, Mitsuyoshi Ota, Chikara Kunisaki, and Itaru Endo have no conflicts of interest or financial ties to disclose.

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Watanabe, J., Ishibe, A., Suwa, Y. et al. Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study. Surg Endosc 34, 202–208 (2020). https://doi.org/10.1007/s00464-019-06751-9

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