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Indocyanine green fluorescence angiography: a new ERAS item

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Abstract

ERAS protocol and indocyanine green fluorescence angiography (ICG-FA) represent the new surgical revolution minimizing complications and shortening recovery time in colorectal surgery. As of today, no studies have been published in the literature evaluating the impact of the ICG-FA in the ERAS protocol for the patients suitable for colorectal surgery. The aim of our study was to assess whether the systematic evaluation of intestinal perfusion by ICG-FA could improve patients outcomes when managed with ERAS perioperative protocol, thus reducing surgical complication rate. This is a retrospective case–control study. From March 2014 to April 2017, 182 patients underwent laparoscopic colorectal surgery for benign and malignant diseases. All the patients were enrolled in ERAS protocol. Two groups were created: Group A comprehended 107 patients managed within the ERAS pathway only and Group B comprehended 75 patients managed as well as with ERAS pathway plus the intraoperative assessment of intestinal perfusion with ICG-FA. Two board-certified laparoscopic colorectal surgeons jointly performed all procedures. Six (5.6%) clinically relevant anastomotic leakages (AL) occurred in Group A, while there was none in Group B, demonstrating that ICG-FA integrated in the ERAS protocol can lead to a statistically significant reduction of the AL. Mean operative time between the two groups was not statistically significant. In five cases (6.6%), the demarcation line set by the fluorescence made the surgeon change the resection line previously marked. The prevalence of all other complications did not differ statistically between the two groups. Our study confirms that combination between ICG and ERAS protocol is feasible and safe and reduces the anastomotic leakage, possibly leading to consider ICG-FA as a new ERAS item.

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References

  1. Basse L, Thorbol JE, Kehleth H (2004) Colonic surgery with accelerated rehabilitation or conventional care Dis. Colon Rectum 47:271–278. https://doi.org/10.1007/s10350-003-0055-0

    Article  Google Scholar 

  2. Eskicioglu C, Forbes SS, Aarts M-A, Okainec A, McLeod RS (2009) Enhnced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg 13:2321–2329. https://doi.org/10.1007/s11605-009-0927-2

    Article  PubMed  Google Scholar 

  3. Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP (2009) Fast track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24:1119–1131. https://doi.org/10.1007/s00384-009-0703-5

    Article  PubMed  Google Scholar 

  4. Teeuwen PHE, Bleichrodt RP, Strik C et al (2010) Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg 14:88–95. https://doi.org/10.1007/s11605-009-1037-x

    Article  PubMed  Google Scholar 

  5. Zagar-Shoshtari K, Hill AG (2008) Optimization of perioperative care for colonic surgery: a review of the evidence ANZ. J Surg 78:13–23. https://doi.org/10.1111/j.1445-2197.2007.04350.x

    Article  Google Scholar 

  6. Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793. https://doi.org/10.1016/s0140-6736(08)60357-8

    Article  PubMed  Google Scholar 

  7. Wick- EC, Shore AD, Hirose K et al (2011) Readmission rates and cost following colorectal surgery. Dis Colon Rectum 54:1475–1479. https://doi.org/10.1097/dcr.0b013e31822ff8f0

    Article  PubMed  Google Scholar 

  8. Gatt M, Anderson ADG, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92:1354–1362. https://doi.org/10.1002/bjs.5187

    Article  CAS  PubMed  Google Scholar 

  9. Hendry PO, Hausel J, Nygren J et al (2009) Determinants of outcome after colorectal resection within an enhanced recovery programme. Br J Surg 11:902–908. https://doi.org/10.1002/bjs.6445

    Article  Google Scholar 

  10. Wind J, Polle S, FungKon Jin PH et al (2009) Laparoscopy and/or fast track multimomodal management versus standard care (LAFA) study group; enhanced recovery after surgery (ERAS) group. Systematic review of enhanced recovery programmes in colonic surgery. BR J Surg. 93:800–809. https://doi.org/10.1002/bjs.5384

    Article  Google Scholar 

  11. Walter CJ, Collin J, Dumville JC, Drew PJ, Monson JR (2009) Enhanced recovery in colorectal resection: a systematic review and meta-analysis. Colorectal Dis. 11:344–353. https://doi.org/10.1111/j.1463-1318.2009.01789.x

    Article  CAS  PubMed  Google Scholar 

  12. Kingham TP, Pachter HL (2009) Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 208:269–278. https://doi.org/10.1016/j.jamcollsurg.2008.10.015

    Article  PubMed  Google Scholar 

  13. Branagan G, Finnis D, Wessex Colorectal Cancer Audit Working Group (2005) Prognosis after anastomotic leakagein colorectal surgery. Dis Colon Rectum 48:1021–1026. https://doi.org/10.1007/s10350-004-0869-4

    Article  PubMed  Google Scholar 

  14. 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. https://doi.org/10.1097/sla.0b013e3182128929

    Article  PubMed  Google Scholar 

  15. Kang CY, Halaby WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 148:65–71. https://doi.org/10.1001/2013.jamasurg.2

    Article  PubMed  Google Scholar 

  16. Kim MJ, Shin R, Oh HK, Park JW, Jeong SY, Park JG (2011) The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg 35(12):2806–2810. https://doi.org/10.1007/s00268-011-1286-1

    Article  PubMed  Google Scholar 

  17. Park JS, Choi GS, Kim SH et al (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257(4):665–671. https://doi.org/10.1097/sla.0b013e31827b8ed9

    Article  PubMed  Google Scholar 

  18. Klein M, Gogenur I, Rosenberg J (2012) Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ 34:e6166. https://doi.org/10.1136/bmj.e6166

    Article  CAS  Google Scholar 

  19. Al Asari S, Cho MS, Kim NK (2015) Safe Anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: a narrative review and outcomes study from an experttertiary center. Eur J Surg Oncol 41(2):175–185. https://doi.org/10.1016/j.ejso.2014.10.060

    Article  Google Scholar 

  20. Frasson M, Flor-Lorente B, Ramos Rodriguez JL, Granero-Castro P, Hervas D, Alvarez Rico MA, Brao MJ, Sanchez Gonzalez JM, Garcia-Granero, ANACO Study Group (2015) Risk factors for anastomotic leakage after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg 262(2):321–330. https://doi.org/10.1097/sla.0000000000000973

    Article  PubMed  Google Scholar 

  21. Boni L, David G, Dionigi G, Rausei S, Cassinotti E, Fingerhut A (2015) Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection. Surg Endosc 30:2736–2742. https://doi.org/10.1007/s00464-015-4540-z

    Article  PubMed  PubMed Central  Google Scholar 

  22. Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, Van Dam GM (2009) Surgeons lack predicting accuracy for anastomtic leakage in gastrointestinal surgery. Int J Colorectal Dis 24(5):569–576. https://doi.org/10.1007/s00384-009-0658-6

    Article  CAS  PubMed  Google Scholar 

  23. Markus PM, Martell J, Leister I, Horstmann O, Brinker J, Becker H (2005) Predicting postoperative morbidity by clinical assessment. Br J Surg 92:101–106. https://doi.org/10.1002/bjs.4608

    Article  CAS  PubMed  Google Scholar 

  24. Urbanavicius L, Pattyn P, de Hutte DV, Benskutonis D (2011) How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg 3:59–69. https://doi.org/10.4240/wjgs.v3.i5.59

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nachiappan S, Askari A, Currie A, Kennedy RH, Faiz O (2014) Intraoperative assessment of colorectal anastomotic intergrity: a systematic review. Surg Endosc 28:2513–2530. https://doi.org/10.1007/s00464-014-3520-z

    Article  PubMed  Google Scholar 

  26. Hagiike M, Phillips EH, Berci G (2007) performance differences in laparoscopic surgical skills between true high-definition and three-chip CCD video systems. Surg Endosc 21:1849–1854. https://doi.org/10.1007/s00464-007-9541-0

    Article  CAS  PubMed  Google Scholar 

  27. Kunert W, Storz P, Muller S, Axt S, Kirschniak A (2013) 3D in laparoscopy: state of the art. Chirurg 84:202–207. https://doi.org/10.1007/s00104-012-2459-7

    Article  CAS  PubMed  Google Scholar 

  28. Honeck P, Wendt-Nordahl G, Rassweiler J, Knoll T (2012) Three-dimensional laparoscopic imaging improves surgical performance on standardized ex vivo laporscopic tasks. J Endourol 26:1085–1088. https://doi.org/10.1089/end.2011.0670

    Article  PubMed  Google Scholar 

  29. Boni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, Cassinotti E, Fingerhut A (2015) Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc 29:2046–2055. https://doi.org/10.1007/s00464-014-3895-x

    Article  PubMed  Google Scholar 

  30. Jafari MD, EWexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ (2014) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study journal of the american college of surgeons 220(1):82–92.e1. https://doi.org/10.1016/j.jamcollsurg.2014.09.015

    Article  Google Scholar 

  31. Degette TH, Andersen HS, Ismail G (2016) Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langhenbecks Arch Surg 401:767–775. https://doi.org/10.1007/s00423-016-1400-9

    Article  Google Scholar 

  32. Boni L, Fingerhut A, Marzorati A et al (2016) Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 31:1836. https://doi.org/10.1007/s00464-016-5181-6

    Article  PubMed  Google Scholar 

  33. Zhuang Cheng-Le, Ye Xing-Zhao, Zhang Xiao-Dong, Chen Bi-Cheng, Zhen Yu (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized contraolled trials. Dis Colon Rectum 56:667–678. https://doi.org/10.1097/dcr.0b013e3182812842

    Article  PubMed  Google Scholar 

  34. Keane C, Savage S, McFarlane K, Seigne R, Robertson G, Eglinton T (2011) Enhanced recovery after surgery versus conventional care in colonic rectal surgery. ANZ J Surg 82:697–703. https://doi.org/10.1111/j.1445-2197.2012.06139.x

    Article  Google Scholar 

  35. Brescia A, Tomassini F, Berardi G, Sebastiani C, Pezzatini M, Dall’Oglio A, Laracca G, Apponi F, Gasparrini M (2017) Development of an enhanced recovery after surgery (ERAS) protocol in laparoscopic colorectal surgery: results of the first 120 consecutive cases from a university hospital. Updates Surg 8:1–7. https://doi.org/10.1007/s13304-017-0432-1

    Article  Google Scholar 

  36. Imboden S, Papadia A, Nauwerk M, McKinnon B, Kollmann Z, Mohr S, Lanz S, Mueller MD (2015) A comparison of radiocolloid and indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery. Ann Surg Oncol 22(13):4198–4203. https://doi.org/10.1245/s10434-015-4701-2 (Epub 2015 Jun 30)

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rossetti D, Vitale SG, Tropea A, Biondi A, Laganà AS (2017) New procedures for the identification of sentinel lymph node: shaping the horizon of future management in early stage uterine cervical cancer. Updates Surg. 69(3):383–388. https://doi.org/10.1007/s13304-017-0456-6 (Epub 2017 May 2)

    Article  PubMed  Google Scholar 

  38. Rossi EC, Ivanova A, Boggess JF (2012) Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study. Gynecol Oncol 124(1):78–82. https://doi.org/10.1016/j.ygyno.2011.09.025 (Epub 2011 Oct 11)

    Article  PubMed  Google Scholar 

  39. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes Pekolij J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron J, Makuchi M (2009) The Clavien-Dindo classification of surgical complication five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/sla.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  40. Gustafsson UO et al (2012) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) Society recommendations. Clin Nutr 31(6):783–800. https://doi.org/10.1007/s00268-012-1772-0

    Article  CAS  PubMed  Google Scholar 

  41. Qu H, Liu Y, Bi DS (2015) Clinical risk factors for anastomotic leakage after lasparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617. https://doi.org/10.1007/s00464-015-4117-x

    Article  PubMed  Google Scholar 

  42. Kim JS, Cho SY, Min BS, Kim NK (2009) Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 209:694–701. https://doi.org/10.1016/j.jamcollsurg.2009.09.021

    Article  PubMed  Google Scholar 

  43. Brescia A, Mari FS, Favi F, Milillo A, Nigri G, Dall’oglio A, Pancaldi A, Masoni L (2013) Laparoscopic lower anterior rectal resection using a curved stapler: original technique and preliminary experience. Am Surg 79(3):253–256

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Azienda Ospedaliera Sant’Andrea, Facoltà di Medicina e Psicologia, Università di Roma, La Sapienza, Rome, Italy

    Antonio Brescia, Massimo Pezzatini, Gherardo Romeo, Matteo Cinquepalmi, Fioralba Pindozzi, Anna Dall’Oglio & Marcello Gasparrini

  2. Second Surgical Clinic of Timisoara Country Hospital, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania

    Fulger Lazar

  3. Division of Week and Day Surgery, Department of Surgery, Sant’Andrea Hospital, II Faculty of Medicine and Surgery “Sapienza” University, Rome, Italy

    Antonio Brescia, Massimo Pezzatini, Gherardo Romeo, Matteo Cinquepalmi, Fioralba Pindozzi, Anna Dall’Oglio & Marcello Gasparrini

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  1. Antonio Brescia
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Correspondence to Matteo Cinquepalmi.

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Brescia, A., Pezzatini, M., Romeo, G. et al. Indocyanine green fluorescence angiography: a new ERAS item. Updates Surg 70, 427–432 (2018). https://doi.org/10.1007/s13304-018-0590-9

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