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The incidence, risk factors, and new prediction score for fluorescence abnormalities of near-infrared imaging using indocyanine green in laparoscopic low anterior resection for rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Several studies have reported the efficacy of near-infrared imaging using indocyanine green in laparoscopic low anterior resection (LAR), but a detailed examination of its fluorescence abnormalities is still insufficient. The purpose of this study was to clarify the incidence of fluorescence abnormalities and to create a new prediction score in laparoscopic LAR.

Methods

This was a retrospective, multicenter study that included patients with rectal cancer who underwent laparoscopic LAR from September 2014 to November 2018.

Results

A total of 336 patients were included. The transection line was changed due to fluorescence abnormalities in 5.4% (18/336) of cases, and the median length of additional resection was 70 mm. Anastomotic leakage of Clavien-Dindo grade ≥ II occurred in 6.0% (20/336). The gender and the intraoperative pre-planned proximal margin (IpPM) were significant factors for fluorescence abnormalities. We devised the fluorescence abnormality prediction score (FAPS) derived from the gender, IpPM, and tumor height from the anal verge (TumorAV). The area under the curve of the FAPS was 0.784 (95% CI: 0.677–0.891). When the cutoff was 4, the sensitivity was 0.833, and the specificity was 0.626. The preoperative pre-planned proximal margin (PpPM) was calculated as follows: PpPM (mm) = 189 (mm) – TumorAV (mm) + 61 × Male (1/0). The proximal margin should be set to be larger than the PpPM to avoid fluorescence abnormalities.

Conclusion

The incidence of fluorescence abnormalities in laparoscopic LAR was 5.4%. If the FAPS is used, the PpPM may be set from the viewpoint of the blood perfusion.

Trial registration

Japanese Clinical Trials Registry: UMIN000032654 (http://www.umin.ac.jp/ctr/index.htm).

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References

  1. Toiyama Y, Kusunoki M (2020) Changes in surgical therapies for rectal cancer over the past 100 years: a review. Ann Gastroenterol Surg 4:331–342. https://doi.org/10.1002/ags3.12342

    Article  PubMed  PubMed Central  Google Scholar 

  2. Akagi T, Inomata M (2020) Essential Updates 2018/2019: Essential advances in surgical and adjuvant therapies for colorectal cancer. Ann Gastroenterol Surg 4(1):39–46. https://doi.org/10.1002/ags3.12307

    Article  PubMed  PubMed Central  Google Scholar 

  3. Watanabe J, Ishibe A, Suwa Y, Suwa H, Ota M, Kunisaki C, Endo I (2020) 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(1):202–208. https://doi.org/10.1007/s00464-019-06751-9

    Article  PubMed  Google Scholar 

  4. Shen Y, Yang T, Yang J, Meng W, Wang Z (2020) Intraoperative indocyanine green fluorescence angiography to prevent anastomotic leak after low anterior resection for rectal cancer: a meta-analysis. ANZ J Surg. https://doi.org/10.1111/ans.15809

  5. Ellebæk MB, Rahr HB, Boye S, Fristrup C, Qvist N (2019) Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study. Color Dis 21:1387–1396. https://doi.org/10.1111/codi.14781

    Article  Google Scholar 

  6. Sverrisson I, Folkvaljon F, Chabok A, Stattin P, Smedh K, Nikberg M (2019) Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer. Eur J Surg Oncol 45(3):341–346. https://doi.org/10.1016/j.ejso.2018.11.015

    Article  PubMed  Google Scholar 

  7. (2017) Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Color Dis 19(8):e296–e311. https://doi.org/10.1111/codi.13646

  8. Endo I, Kumamoto T, Matsuyama R (2017) Postoperative complications and mortality: are they unavoidable? Ann Gastroenterol Surg 1(3):160–163. https://doi.org/10.1002/ags3.12045

    Article  PubMed  PubMed Central  Google Scholar 

  9. Thompson SK, Chang EY, Jobe BA (2006) Clinical review: healing in gastrointestinal anastomoses, Part I. Microsurgery 26(3):131–136. https://doi.org/10.1002/micr.20197

    Article  PubMed  Google Scholar 

  10. 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(1):15–23. https://doi.org/10.1007/s10151-017-1731-8

    Article  CAS  PubMed  Google Scholar 

  11. 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(4):1836–1840. https://doi.org/10.1007/s00464-016-5181-6

    Article  PubMed  Google Scholar 

  12. 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(10):1359–1367. https://doi.org/10.1002/bjs.10844

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  14. Kawada K, Sakai Y (2016) Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J Gastroenterol 22(25):5718–5727. https://doi.org/10.3748/wjg.v22.i25.5718

    Article  PubMed  PubMed Central  Google Scholar 

  15. Qin Q, Ma T, Deng Y, Zheng J, Zhou Z, Wang H, Wang L, Wang J (2016) Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection. Dis Colon Rectum 59(10):934–942. https://doi.org/10.1097/dcr.0000000000000665

    Article  PubMed  Google Scholar 

  16. Richards CH, Campbell V, Ho C, Hayes J, Elliott T, Thompson-Fawcett M (2012) Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection. Color Dis 14(5):628–633. https://doi.org/10.1111/j.1463-1318.2011.02718.x

    Article  CAS  Google Scholar 

  17. Hoshino N, Hida K, Sakai Y, Osada S, Idani H, Sato T, Takii Y, Bando H, Shiomi A, Saito N (2018) Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer. Int J Color Dis 33(4):411–418. https://doi.org/10.1007/s00384-018-2970-5

    Article  Google Scholar 

  18. Van Der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218. https://doi.org/10.1016/s1470-2045(13)70016-0

    Article  PubMed  Google Scholar 

  19. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774. https://doi.org/10.1016/s1470-2045(14)70205-0

    Article  PubMed  Google Scholar 

  20. Stevenson ARL, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer. JAMA 314(13):1356–1363. https://doi.org/10.1001/jama.2015.12009

    Article  CAS  PubMed  Google Scholar 

  21. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PWT, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes. JAMA 314(13):1346–1355. https://doi.org/10.1001/jama.2015.10529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This research project did not receive any financial support.

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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

    Hiroki Ohya, Jun Watanabe, Yusuke Suwa & Chikara Kunisaki

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

    Hirokazu Suwa

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

    Mayumi Ozawa, Atsushi Ishibe & Itaru Endo

Authors
  1. Hiroki Ohya
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  2. Jun Watanabe
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  3. Yusuke Suwa
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  4. Hirokazu Suwa
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  5. Mayumi Ozawa
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  6. Atsushi Ishibe
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  7. Chikara Kunisaki
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  8. Itaru Endo
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Corresponding author

Correspondence to Jun Watanabe.

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The authors declare that they have no conflict of interest.

Ethics approval

This study protocol was approved by the Ethical Advisory Committee of Yokohama City University Medical Center and the institutional review board of each participating hospital before the study was initiated.

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Due to the retrospective nature of the study, a written informed consent was not obtained. We used the opt-out approach to disclose the study information.

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Ohya, H., Watanabe, J., Suwa, Y. et al. The incidence, risk factors, and new prediction score for fluorescence abnormalities of near-infrared imaging using indocyanine green in laparoscopic low anterior resection for rectal cancer. Int J Colorectal Dis 36, 395–403 (2021). https://doi.org/10.1007/s00384-020-03776-8

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  • DOI: https://doi.org/10.1007/s00384-020-03776-8

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