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Visualization and quantification of anastomotic perfusion in colorectal surgery using near-infrared fluorescence

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Abstract

Background

Anastomotic leakage (AL) is one of the most troublesome complications in colorectal surgery. Recently, near-infrared fluorescence (NIRF) imaging has been used intraoperatively to detect sentinel lymph nodes and visualize the blood supply at the region of interest (ROI). The aim of this study was to evaluate the role of visualization and quantification of bowel perfusion around the anastomosis using NIRF system in predicting AL.

Methods

A prospective study was conducted on patients who had laparoscopic surgery for colorectal cancer at our institution. Perfusion of the anastomosis was evaluated with NIRF imaging after intravenous injection of indocyanine green (ICG). The time course of fluorescence intensity was recorded by an imaging analyzer We measured the time from ICG injection to the beginning of fluorescence (T0), maximum intensity (Imax), time to reach Imax (Tmax), time to reach Imax 50% (\(T_{{{ \text{max} }_{1/2} }}\)) and slope (S) after the anastomosis.

Results

Tumor locations were as follows; cecum: 2, ascending colon: 2, transverse colon: 7, descending colon: 1, sigmoid colon: 2, rectosigmoid colon: 3 and rectum: 6 (one case with synchronous cancer). All operations were performed laparoscopically. Four patients were diagnosed with or suspected to have AL (2 patients with grade B anastomotic leakage after low anterior resection, 1 patient with minor leakage in transverse colon resection and 1 patient needing re-anastomosis intraoperatively in transverse colon resection). T0 was significantly longer in the AL group than in patients without AL (64.3 ± 27.6 and 18.2 ± 6.6 s, p = 2.2 × 10−3).

Conclusions

Perfusion of the anastomosis could be successfully visualized and quantified using NIRF imaging with ICG. T0 might be a useful parameter for prediction of AL.

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Abbreviations

AL:

Anastomotic leakage

NIRF:

Near-infrared fluorescence

ICG:

Indocyanine green

UMIN-CTR:

University Hospital Medical Information Network Clinical Trial Registry

FEEA:

Functional end-to-end anastomosis

DST:

Double stapling technique

SPIES:

Storz Professional Image Enhancement system

ROI:

Region of interest

ASA:

American Society of Anesthesiologists

UICC TNM classification:

The Union for International Cancer Control’s tumor-node-metastasis classification

ISGRC:

The International Study Group of Rectal Cancer

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Acknowledgements

We acknowledge editing and proofreading by Benjamin Phillis, Clinical Study Support Center, Wakayama Medical University.

Funding

There is no funding or material support on this study.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan

    S. Hayami, K. Matsuda, H. Iwamoto, M. Ueno, M. Kawai, S. Hirono, K. Okada, M. Miyazawa, K. Tamura, Y. Mitani, Y. Kitahata, Y. Mizumoto & Hiroki Yamaue

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  1. S. Hayami
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  2. K. Matsuda
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  3. H. Iwamoto
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  4. M. Ueno
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  5. M. Kawai
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  6. S. Hirono
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  7. K. Okada
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  8. M. Miyazawa
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  9. K. Tamura
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  10. Y. Mitani
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  11. Y. Kitahata
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  12. Y. Mizumoto
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  13. Hiroki Yamaue
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Corresponding author

Correspondence to Hiroki Yamaue.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by Wakayama Medical University Ethical Committee (approval number: 1418) and registered on University Hospital Medical Information Network (UMIN) Clinical Trial Registry (UMIN-CTR, UMIN000022876).

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Written informed consent was obtained from all participants included in this study.

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Hayami, S., Matsuda, K., Iwamoto, H. et al. Visualization and quantification of anastomotic perfusion in colorectal surgery using near-infrared fluorescence. Tech Coloproctol 23, 973–980 (2019). https://doi.org/10.1007/s10151-019-02089-5

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  • DOI: https://doi.org/10.1007/s10151-019-02089-5

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