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Quantitative evaluation of colon perfusion after high versus low ligation in rectal surgery by indocyanine green: a pilot study

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Abstract

Background

In the field of rectal cancer surgery, there remains ongoing debate on the merits of high ligation (HL) and low ligation (LL) of the inferior mesenteric artery (IMA) in terms of perfusion and anastomosis leakage. Recently, infrared fluorescence of indocyanine green (ICG) imaging has been used to evaluate perfusion status during colorectal surgery.

Objective

The purpose of this study is to compare the changes in perfusion status between HL and LL through quantitative evaluation of ICG.

Methods

Patients with rectosigmoid or rectal cancer were randomized into a high or LL group. ICG was injected before and after IMA ligation, and region of interest (ROI) values were measured by an image analysis program (HSL video©).

Results

From February to July 2020, 22 patients were enrolled, and 11 patients were assigned to each group. Basic demographics were similar between the two groups, except for albumin level and cardiac ejection fraction. There were no significant differences in F_max between the two groups, but T_max was significantly higher and Slope_max was significantly lower in the HL group than in the LL group. Anastomosis leakage was significantly associated with neoadjuvant chemoradiation and F_max.

Conclusion

After IMA ligation, T_max increased and Slope_max decreased significantly in the HL group. However, the intensity of perfusion status (F_max) did not change according to the level of IMA ligation.

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Acknowledgements

I would like to express my gratitude to Hae-Won Shin who helped illustration and Keunheung Park who helped with the ICG quantification program.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Seung-Rim Han, Chul Seung Lee, Jung Hoon Bae, Hyo Jin Lee, Mi Ran Yoon, Abdullah Al-Sawat, Do Sang Lee, In Kyu Lee & Yoon Suk Lee

  2. Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia

    Abdullah Al-Sawat

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  1. Seung-Rim Han
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Correspondence to Yoon Suk Lee.

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Drs. Seung-Rim Han, Chul Seung Lee, Jung Hoon Bae, Hyo Jin Lee, Mi Ran Yoon, Abdullah Al-Sawat, Do Sang Lee, In Kyu Lee, and Yoon Suk Lee have no conflicts of interest or financial ties to disclose.

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Han, SR., Lee, C.S., Bae, J.H. et al. Quantitative evaluation of colon perfusion after high versus low ligation in rectal surgery by indocyanine green: a pilot study. Surg Endosc 36, 3511–3519 (2022). https://doi.org/10.1007/s00464-021-08673-x

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  • DOI: https://doi.org/10.1007/s00464-021-08673-x

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