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The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study

International Journal of Clinical Oncology volume 24, pages 394–402 (2019)Cite this article

Abstract

Background

It remains unclear whether indocyanine green (ICG) angiography could reduce the rate of postoperative anastomotic leakage (AL) following rectal surgery. The aim was to determine whether intraoperative ICG angiography could decrease symptomatic AL following laparoscopic low anterior resection (LAR).

Methods

This is a retrospective study of 149 patients with rectal cancer who underwent laparoscopic LAR at a single institution. Propensity score matching (PSM) was employed to compare groups with and without ICG angiography.

Results

Before PSM, the symptomatic AL rate was 10.4% (5/48) in patients with ICG angiography, compared with 6.9% (7/101) in cases without ICG angiography (P = 0.52). In patients with ICG angiography, poor perfusion of the proximal colon judged by ICG angiography led to additional colon resection in 27.1% (13/48). Symptomatic AL occurred in 30.8% (4/13) of the patients who had revision of the transection site, whereas it occurred in only 2.9% (1/35) of the patients who did not need revision of the transection site (P = 0.015). After PSM, the symptomatic AL rate was 8.8% (3/34) in patients with ICG angiography, compared with 14.7% (5/34) in cases without ICG angiography (P = 0.71). In univariate analysis, high BMI, preoperative chemotherapy, and lateral lymph node dissection were significantly associated with symptomatic AL. Multivariate analysis indicated that only lateral lymph node dissection remained significantly associated with AL (odds ratio, 10.05; 95% confidence interval, 1.75–58.61; P = 0.011).

Conclusions

Intraoperative ICG angiography is useful for prediction of AL following laparoscopic LAR.

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Acknowledgements

The authors thank medical staffs and residents of Kyoto University Hospital gastrointestinal surgery for their participation in this study. We could not have completed the study without their diligence and support.

Funding

No funding was received.

Author information

Author notes

  1. Toshiaki Wada and Kenji Kawada contributed equally to this work.

Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, 606-8507, Kyoto, Japan

    Toshiaki Wada, Kenji Kawada, Nobuaki Hoshino, Susumu Inamoto, Mami Yoshitomi, Koya Hida & Yoshiharu Sakai

Authors
  1. Toshiaki Wada
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  2. Kenji Kawada
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  3. Nobuaki Hoshino
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  4. Susumu Inamoto
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  5. Mami Yoshitomi
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  6. Koya Hida
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  7. Yoshiharu Sakai
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Corresponding author

Correspondence to Kenji Kawada.

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Conflict of interest

Drs. Toshiaki Wada, Kenji Kawada, Nobuaki Hoshino, Susumu Inamoto, Mami Yoshitomi, Koya Hida, and Yoshiharu Sakai have no conflicts of interest or financial ties to disclose.

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 and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Wada, T., Kawada, K., Hoshino, N. et al. The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study. Int J Clin Oncol 24, 394–402 (2019). https://doi.org/10.1007/s10147-018-1365-5

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  • DOI: https://doi.org/10.1007/s10147-018-1365-5

Keywords

  • Rectal cancer
  • ICG angiography
  • Anastomotic leakage
  • Low anterior resection
  • A propensity score-matched study