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Impact of near-infrared fluorescence imaging with indocyanine green on structural sequelae of anastomotic leakage after laparoscopic intersphincteric resection of malignant rectal tumors

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Abstract

Background

Recent studies have indicated the potential benefit of intraoperative near-infrared fluorescence imaging (NIR-FI) with indocyanine green in reducing early anastomotic leakage in colorectal surgery. Nonetheless, whether NIR-FI is effective in reducing structural sequelae of anastomotic leakage (SSAL) remains unclear. The aim of the present study was to investigate the impact of NIR-FI on SSAL after laparoscopic intersphincteric resection (ISR) of malignant rectal tumors.

Methods

This study was a retrospective single-center cohort study. A total of 293 consecutive patients who underwent elective laparoscopic ISR from May 2010 to August 2017 were included. Patients were divided into 2 groups; those who underwent elective laparoscopic ISR with lymphadenectomy for malignant rectal tumors using NIR-F (NIR-FI group) and those who underwent elective laparoscopic ISR with lymphadenectomy for malignant rectal tumors without using NIR-FI (control group). Thirty were excluded from the analyses (13 died, 7 had pelvic recurrence, and 10 were lost to follow-up). The primary endpoint was the rate of SSAL within 2 years after the primary resection, whereas the secondary endpoint was the rate of natural defecation via the anus at 2 years after the primary resection. Using various statistical analyses, such as propensity score matching, the rate of SSAL was compared between groups.

Results

A total of 263 patients were analyzed [177 males and 86 females, median age 61 (27–84) years]. Prior to propensity score matching (n = 263), NIR-FI was performed in 70 patients (26.6%) The rates of SSAL were 1.4% (1/70) in the NIR-FI group and 10.4% (20/193) in the control group (p = 0.02). After propensity score matching (n = 163), the rates of SSAL were 1.5% (1/66) in the NIR-FI group and 11.7% (12/103) in the control group (p = 0.02). Propensity score analyses, as well as simple regression analyses, revealed that NIR-FI was associated with a significantly lower risk of SSAL (OR 0.10–0.13; p = 0.03–0.05).

Conclusions

NIR-FI is useful in reducing the rate of SSAL after laparoscopic ISR.

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Availability of data

The datasets of the current study are available from the corresponding author on reasonable request.

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Funding

This study received departmental support only, and there was no grant support or other specific funding for this study.

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Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    H. Hasegawa, Y. Tsukada, T. Sasaki, Y. Nishizawa, K. Ikeda, N. Takeshita, K. Teramura & M. Ito

  2. Surgical Device Innovation Office, NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Japan

    H. Hasegawa, N. Takeshita & M. Ito

  3. Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital East, Kashiwa, Japan

    M. Wakabayashi & S. Nomura

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  1. H. Hasegawa
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by HH, YT, MW, and SN. The first draft of the manuscript was written by HH, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to M. Ito.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in accordance with the principles outlined in the Declaration of Helsinki, and the study protocol was approved by the Institutional Review Board of the National Cancer Center (2018-100).

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

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Hasegawa, H., Tsukada, Y., Wakabayashi, M. et al. Impact of near-infrared fluorescence imaging with indocyanine green on structural sequelae of anastomotic leakage after laparoscopic intersphincteric resection of malignant rectal tumors. Tech Coloproctol 26, 561–570 (2022). https://doi.org/10.1007/s10151-022-02631-y

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