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Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors



Whether indocyanine green fluorescence angiography (ICG-FA) during rectal surgery is effective in reducing anastomotic leakage remains unclear. This study aimed to investigate the effect of intraoperative ICG-FA on anastomotic leakage after sphincter-sparing surgery for malignant rectal tumors.


This was a retrospective, single-center cohort study conducted on 852 consecutive patients who underwent laparoscopic sphincter-sparing surgery from January 2007 to June 2017 at our institution. The incidence of anastomotic leakage was compared between patients who underwent ICG-FA to determine the proximal resection margin and those in whom this technique was not performed, using logistic regression analysis, including propensity score.


A total of eight patients were excluded (one patient with previous low anterior resection and seven patients who underwent simultaneous resection for other primary cancers), resulting in 844 patients being analyzed. Before propensity score matching, 141 patients (16.7%) who underwent ICG-FA were compared with 703 patients (83.3%) in whom ICG-FA was not performed. The incidence of anastomotic leakage was 2.8% (4/141) in the ICG-FA group and 12.4% (87/703) in the control group (p = 0.001). After propensity score matching (n = 420), the patient characteristics between the two groups were well balanced, and the incidence of anastomotic leakage was 2.8% (4/141) in the ICG-FA group and 13.6% (38/279) in the control group (p = 0.001). Logistic regression analyses using propensity score showed that patients who underwent ICG-FA had significantly lower odds of anastomotic leakage.


Intraoperative ICG-FA is a promising method to reduce anastomotic leakage after laparoscopic rectal surgery.

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This study has not received any direct or indirect funding from extramural sources.

Author information

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by H.H., Y.T., M.W., and S.N. The first draft of the manuscript was written by H.H. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to Masaaki Ito.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (National Cancer Center Institutional Review Board; reference no. 2017-410) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The requirement for acquisition of informed consent from patients was waived owing to the retrospective nature of this study.

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In the estimated propensity score matched cohort, all adjustment covariates were well balanced, which resulted in a decrease in standardized differences. ASA-PS, American Society of Anesthesiologists physical status classification; BMI, body mass index; LLND, lateral lymph node dissection. (PDF 7 kb)

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Cite this article

Hasegawa, H., Tsukada, Y., Wakabayashi, M. et al. Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors. Int J Colorectal Dis 35, 471–480 (2020).

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  • Indocyanine green
  • Fluorescence angiography
  • Anastomotic leakage
  • Sphincter-sparing surgery