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Near-infrared fluorescence angiography for colorectal surgery is associated with a reduction of anastomotic leak rate

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Abstract

Decreased blood perfusion at the anastomotic site increases the risk of anastomotic leakage (AL) following colorectal surgery. Indocyanine green near-infrared fluoroangiography (NIRF/ICG) is a technique that allows for the assessment of intestinal perfusion before and after the formation of an anastomosis. We aimed to compare the rate of AL after colorectal surgery conducted with NIRF/ICG assessing vascular anastomotic perfusion and without this support. The data of patients who underwent colorectal surgery from November 2014 to February 2019 were reviewed retrospectively. Left-sided hemicolectomy, sigmoid resection, and anterior rectal resection were included. Emergency resections were excluded. Procedures conducted with NIRF/ICG and without NIRF/ICG (no-NIRF/ICG) support were compared using Fisher’s and Mann–Whitney U test. Overall, 196 procedures were included, 98 were carried out with no-NIRF/ICG and 98 with NIRF/ICG. Patients’ clinical and intraoperative characteristics were similar in the two groups. In the NIRF/ICG, fluorescence was detected in 100% of the cases; following NIRF/ICG the planned site of transection was changed in eight cases, whereas in one case the anastomosis was re-performed. Overall, six patients (3%) developed an AL, 0% in the NIRF/ICG and 6% (n = 6) in the no-NIRF/ICG group (p = 0.029). Median hospital length of stay was shorter in the NIRF/ICG group [6 days (IQR 6–7) vs. 7 days (IQR 6–9), p < 0.001]. The results of this study suggest that the use of the NIRF/ICG was safe for colorectal surgery and decreases the risk of anastomotic leak. A randomized trial is required to confirm these preliminary data.

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Acknowledgements

The authors thank Dr. Caitlin McIntyre for the English language revision of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy

    Harmony G. Impellizzeri, Alessandra Pulvirenti, Marco Inama, Matilde Bacchion, Enrico Marrano, Milhal Creciun, Andrea Casaril & Gianluigi Moretto

  2. Unit of General and Pancreatic Surgery, University and Hospital Trust of Verona, Verona, Italy

    Alessandra Pulvirenti

Authors
  1. Harmony G. Impellizzeri
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  2. Alessandra Pulvirenti
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  3. Marco Inama
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  4. Matilde Bacchion
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  5. Enrico Marrano
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  6. Milhal Creciun
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Correspondence to Harmony G. Impellizzeri.

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The authors declare that they have no competing interests.

Ethical approval

The study was carried out under ethical recommendations stated in the Helsinki Declaration. The Ethics Committee for Clinical Trials of Verona and Rovigo approved the study protocol (protocol: COLONFLUO/1500CESC).

Informed consent

Informed consent was obtained for patients undergoing NIRF/ICG procedure, whereas for patients undergoing no-NIRF/ICG the need to obtaining informed consent was waived.

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Impellizzeri, H.G., Pulvirenti, A., Inama, M. et al. Near-infrared fluorescence angiography for colorectal surgery is associated with a reduction of anastomotic leak rate. Updates Surg 72, 991–998 (2020). https://doi.org/10.1007/s13304-020-00758-x

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  • DOI: https://doi.org/10.1007/s13304-020-00758-x

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