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A Novel Parameter Identified Using Indocyanine Green Fluorescence Angiography may Contribute to Predicting Anastomotic Leakage in Gastric Cancer Surgery

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Abstract

Background

Anastomotic leak is one of the most serious postoperative complications, and intraoperative adequate perfusion plays a key role in preventing its development in gastric cancer surgery. This study aimed to investigate the relationships between anastomotic leak and the parameters defined by an assessment of intraoperative anastomotic perfusion using a near-infrared indocyanine green (ICG) fluorescence system and to evaluate the usefulness of this ICG fluorescence assessment in gastric cancer surgery.

Methods

We retrospectively reviewed data of 100 patients who underwent gastric cancer surgery. In a visual assessment based on fluorescence intensity, we classified ICG fluorescence image patterns as homogeneous, heterogeneous, or faint. In a chronological assessment, the first or second time point of ICG fluorescence appearance on one or the other side of the anastomosis was defined as FT or ST, respectively. The time difference in ICG fluorescence appearance between FT and ST was defined as TD. The relationships between anastomotic leak and the evaluated clinical factors, including the parameters identified by the ICG fluorescence assessment, were evaluated using univariate or multivariate analysis.

Results

Although no signs of leak were found by surgeons’ subjective judgments, four patients developed postoperative anastomotic leak of Clavien–Dindo grade III or IV. Multivariate analysis revealed that TD was an independent predictor of anastomotic leak (odds ratio 35.361, 95% confidence interval 1.489–839.923, p = 0.027).

Conclusions

A novel parameter identified using near-infrared ICG fluorescence assessment may be useful to predict anastomotic leak in gastric cancer surgery.

Trial Registration

UMIN Clinical Trials Registry: #UMIN000030747 (https://www.umin.ac.jp/ctr/index.htm).

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Acknowledgements

We thank Jane Charbonneau, DVM, from Edanz group (https://jp.edanzgroup.com/) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan

    Mikito Mori, Kiyohiko Shuto, Atsushi Hirano, Chihiro Kosugi, Kazuo Narushima, Isamu Hosokawa, Masafumi Fujino, Masato Yamazaki, Hiroaki Shimizu & Keiji Koda

  2. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan

    Mikito Mori, Atsushi Hirano & Kazuo Narushima

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  1. Mikito Mori
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  2. Kiyohiko Shuto
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  3. Atsushi Hirano
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Correspondence to Mikito Mori.

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This study was approved by the institutional review board of Teikyo University.

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Informed consent was obtained from each participant included in the study.

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Mori, M., Shuto, K., Hirano, A. et al. A Novel Parameter Identified Using Indocyanine Green Fluorescence Angiography may Contribute to Predicting Anastomotic Leakage in Gastric Cancer Surgery. World J Surg 44, 2699–2708 (2020). https://doi.org/10.1007/s00268-020-05488-0

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